Awake Subfascial Breast Augmentation

Surgery Time

1-4 hours

Anesthesia

Local or General

Hospital Stay

Outpatient

Time Off Work

1-2 weeks

Full Recovery

2-4 weeks

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Awake Subfascial Breast Augmentation (Local Anesthesia Only)

At FacePlus Plastic Surgery Institute in Lubbock, TX, Dr. Thanapoom “Mo” Boonipat offers a refined subfascial breast augmentation performed awake under local anesthesia only—no IV or general anesthesia required. This technique places the implant beneath the pectoral fascia but above the pectoralis major muscle, blending the soft-tissue look of subglandular with the support and camouflage benefits of the fascia.

Why the Subfascial Plane?

Natural upper-pole contour: The pectoral fascia provides a thin, supportive layer that helps soften edges and reduce visible rippling in appropriately selected patients.
Preserves muscle function: Because the pectoralis is not released, patients avoid animation deformity associated with some submuscular placements.
Comfortable recovery: Less muscle disruption typically means less post-op tightness and a faster return to light activity.

Who Is a Good Candidate for Awake, Local-Only Augmentation?

You may be a candidate if you:

Prefer to avoid general anesthesia and want an outpatient, walk-in/walk-out experience.
Have adequate soft-tissue coverage (or will combine with fat grafting if needed).
Seek a natural slope without a high, “worked-out” upper-pole look.
Have realistic goals, are medically optimized, and can follow peri-operative instructions.

What “Awake Under Local” Feels Like

Comfort plan: Tumescent-style local anesthesia, targeted nerve infiltration, and gentle technique. Most patients describe pressure and vibration, not sharp pain.
Monitoring: Continuous vitals (heart rate, blood pressure, pulse oximetry) and verbal feedback—you can communicate throughout.
No narcotic fog: Many patients return home alert, start a light meal, and resume gentle walking the same day.

(We’ll review your medication plan, allergies, and pre-op instructions in detail; no food/drink guidance and medication timing are tailored to you.)

Step-by-Step: Awake Subfascial Technique

Marking & sizing: Measurements (base width, soft-tissue pinch, IMF position) and implant profile planning.
Local anesthesia: Incremental infiltration in the incision line and along the planned pocket with epinephrine-containing local solution for comfort and hemostasis.
Incision (typically inframammary): Precisely placed within the natural breast crease for predictable scar concealment.
Pocket creation—subfascial: Careful elevation of the pectoralis fascia from the muscle with meticulous hemostasis; the muscle remains intact.
No-touch implant placement: Keller-type funnel and pocket irrigation per our infection-reduction protocol.
Symmetry checks: In-procedure confirmation of footprint, projection, and IMF alignment.
Layered closure & support: Multilayer sutures and placement of a support bra; taping strategy to guide early implant position.

Advantages of Awake, Local-Only Subfascial Augmentation

Avoids general anesthesia and related downtime in suitable candidates
Less muscle pain and typically quicker early recovery
Lower risk of animation deformity vs. submuscular
Real-time feedback: You can speak up if something feels uneven or too tight

Considerations & Limitations

Tissue coverage matters: Very thin patients may benefit from alternative planes or hybrid augmentation (implant + micro-fat grafting).
Upper-pole fullness: Submuscular can create a firmer upper-pole in some anatomies; we’ll simulate both looks.
Capsular contracture & rippling: Risks exist with any plane; careful pocket control and implant selection help mitigate but do not eliminate them.
Not ideal for every revision: Certain revisions or lifts still favor a different plane or general anesthesia.

Recovery: What’s Different When You’re Awake

Same day: Walk out with a support bra; most patients manage soreness with oral meds and cold compresses.
Days 1–3: Tightness and pressure expected; arm mobility exercises begin per our handout.
Days 4–7: Desk work is often reasonable; avoid lifting >10 lbs.
Weeks 2–4: Gradual return to low-impact cardio; no chest workouts until cleared.
3–6 months: Final “drop & fluff,” scar maturation continues up to 12 months.

Safety First at FacePlus PSI

Sterile, no-touch protocol and evidence-based pocket irrigation strategy
Continuous monitoring and Texas Medical Board Board Rule 173–aligned peri-operative standards
Conservative patient selection and clear conversion plan (if intra-op comfort or findings warrant, we’ll pause and reassess rather than push forward)

Implant Selection for the Subfascial Plane

Cohesive silicone (“gummy bear”) options in multiple profiles (moderate, moderate-plus, high) matched to your base width.
Texturing & shell considerations discussed in detail during consult; we prioritize current safety data and your tissue needs.
Optional fat grafting to the upper-pole or cleavage line for patients seeking extra softness or camouflage.

FAQs: Awake, Local-Only Subfascial Augmentation

Will I feel pain during surgery?
You’ll feel pressure or movement, not sharp pain. We add more local anesthetic if you feel anything uncomfortable.

Why not submuscular under local?
Submuscular requires muscle release, which is less comfortable under local alone. Subfascial preserves muscle and is better suited to an awake experience for the right candidate.

Is the result as natural as submuscular?
In properly selected patients, yes—the fascia provides subtle coverage while preserving a soft, natural slope.

What if I’m very athletic or very thin?
We’ll evaluate tissue thickness and activity level. Some athletes still do well subfascial; others may benefit from alternative plans.

How long does it take?
Most cases take about 60–120 minutes depending on anatomy and plan.

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