Gougoutas AJ, Gilson A, Check J, Movassaghi K. Subpectoral vs subfascial cosmetic breast augmentation: are we ready to settle? Aesthet Surg J. 2026;46(3):277-283. doi: 10.1093/asj/sjaf210
Disclosure
Dr. Epstein is a paid investigator in the Motiva U.S. FDA clinical trial and is compensated by Establishment Labs to train surgeons on the Preservé breast augmentation technique. He discloses this relationship in all public communications involving Motiva or Preservé. Dr. Epstein owns stock in Establishment Labs.
What This Study Found
One surgeon's own results, comparing nearly 200 patients who had the traditional under-the-muscle implant placement against a similar number placed just above the muscle (subfascial), both through the same fold incision. The subfascial group had meaningfully fewer complications across the board.
Key Findings
- 193 patients, 386 breasts, single surgeon, 2011 through 2023
- 96 patients (192 breasts) under the muscle; 97 patients (194 breasts) above the muscle, below the fascia
- Capsular contracture: 1.1% (subfascial) vs. 5.2% (under the muscle)
- Lateral implant shifting: 8.8% (subfascial) vs. 23.4% (under the muscle)
- Double-bubble deformity: 0% (subfascial) vs. 3.7% (under the muscle)
- Acute complication rates were statistically similar between the two groups
Why This Matters for Preservé Patients
This is direct, single-surgeon, head-to-head evidence that placing the implant above the muscle carries real, measurable advantages over the traditional under-the-muscle approach, independent of any specific device brand or the tissue-preservation technique itself.
