One of the Originals, Dr. Oyama has delivered  Subfascial breast augmentation since 2002 . If you take ten women, and perform the same operation with the same size breast implant, all ten will look different. The final outcome depends on the body type and shape, the tissue density and fat, age, maternity, the shape of the breast before surgery, even ethnicity. The doctor must discuss these limitations with the patient before surgery, so that unrealistic expectations are avoided.

While outcomes may vary from person to person, the goal is to meet or exceed the expectations of the patient, and to deliver a product with the highest level of quality and consistency, time after time. 

I began my career in breast augmentation in 1998. The first 300 cases or so I performed the industry standard at the time; “ submuscular” or under the pectoralis muscle. I asked myself, “If I were a woman, how would I want to have this operation?”

What are the biggest issues women have with submuscular placement?

1.The implants move to the side whenever you flex your arms a certain way.
2.Sometimes, the implants look really separated.  
3.The cleavage is not there.
4.The postoperative period is extremely painful, to the point of incapacitation.
5.They can still get hard, even when they’re under the muscle
6.They can still look really round and fake, even when they’re under the muscle

Think of Victoria Beckham, and all the Hollywood starlets who have had surgery from the ‘big name” “celebrity surgeons.” 

What women may not realize about submuscular placement:

  1. The implants reside directly on the rib bones. Rubbing on the ribs a million times a day. This may also be contributing to wear on the shell of the implant.

  2. The pectoralis muscle must be completely detached from the ribs, along the bottom and the middle; otherwise the implant will look too high or too lateral. That is why it hurts like the dickens. Do you really want your muscle altered that way?

  3. There is no pectoralis muscle on the bottom or on the sides of the chest.

  4. In time, the bulky part of the pectoralis above will insinuate and migrate to go under the implant. This paradoxically creates more of a rounded, fake look.


I have been doing subfascial breast augmentation since 2002 for close to 1,000 procedures. This has become my number one operation, and my “signature” operation. 

SUBFASCIAL BREAST AUGMENTATION was pioneered by a general surgeon named Dan Metcalf in Oklahoma. He is the busiest cosmetic breast surgeon in the world, performing on average 600 breast augmentations per year consistently. 
The dissection is performed under the deep pectoral fascia, under the top layer of the muscle. I call it "in between the muscle" or "inside the muscle".  As opposed to subglandular placement, the subfascial dissection is a natural plane of dissection, and preserves breast tissue.  The incision is placed at the bottom of the areola.

The advantage of subfascial placement addresses all the issues women have with submuscular. Imagine that you don’t know how good it can be because you don’t know:

1. Natural, anatomic placement mimics real breast movement. There is no displacement with arm movements, and the implants feel softer.

2. Awesome cleavage, even with smaller implants, because the muscle is not separating the implants. You can use smaller implants with subfascial placement to get a bigger result, which is more comfortable for the woman.

3. Contrary to conventional beliefs, the subfascial placement looks MORE NATURAL, NOT round and fake, because it can assume a more teardrop position.

4. Far less pain postoperatively. Our patients usually walk out to the car after surgery, don’t take Vicodin after day one, and are scolded for being too active and feeling too good.

5. For the surgeon, the subfascial procedure takes more time, is performed under direct vision, and because the fascia layer guides the dissection, much more accurate and consistent. The patient deserves quality and consistency, not uneven, lopsided breasts.

6. Subfascial placement definitely fills out droopy breasts better than submuscular, mostly avoiding the need for a breast lift. A “snoopy dog” look is avoided.

Visit our photo gallery and see for yourself. All my breast patients are direct referrals. In fact, a common source for referrals is from the Korean spas, where there is a no-holds barred comparison between women, and we are definitely  “SPA WORTHY”.