Why Do Some People Opt for DUAL Plane Placement? Which is Best for Me? (Photo)

My BA is scheduled for 21 Dec, 2012. I'm still having a hard time decided whether to go Subglandular, Dual Plane, or Submuscular. My current stats are 5'6" and 150 pounds (muscular, I plan on competing in Fitness/Figure competitions next year). I have one child & breastfed for 3 months. I have grade 1-2 ptosis (I think) and would prefer to not have a breast lift, yet. I am a B cup and desire a D cup. My question is which method would be my best option, Subglandular, Dual, or Submuscular, & why?

Doctor Answers (14)

Dual Plane Breast Augmentation

+2

Question is do you really know what dual plane means and does your surgeon really know what it means. Dual plane is when a plane of dissection is performed under the muscle as well as on top of the muscle, thus dual plane. Most people think dual plane means basically under the pectoral muscle with the implant sitting in a plane under the muscle in the upper portion and under the breast in the lower portion . This is not what dual plane means. Anyhow, under the muscle is better than over the muscle in most cases. It appears however, that you would benefit from a lift . If you didn't want a big lift with much scarring you could do a circumareolar lift.


Beverly Hills Plastic Surgeon
5.0 out of 5 stars 48 reviews

Dual plane most common.

+2

Implants for breast augmentation are rarely placed completely submuscular.  Most often the attachments of the pectoralis mucle to the ribs must be released to allow the implant to settle to the level of the inframammary fold.  This means that the implant is partially behind the pectoral muscle (sub-pectoral) and partially behind the breast tissue- behind 2 layers, or "dual plane." There are several advantages to this type of placement.  Usually the result looks more natural.  There is a much lower rate of capsular contracture (hard scar tissue around the implant) compared to sub-mammary placement (under the breast tissue but over the muscle).  Also, mammography is easier to perform with dual plane placement.

Bruce Genter, MD
Abington Plastic Surgeon
4.0 out of 5 stars 11 reviews

What plane for breast implant placement?

+2

First of all, there is no scientific evidence that the rate of capsular contracture is greater or less depending on its plane of placement.  Second, sub-muscular, sub-pectoral and dual plane are synonymous in breast augmentation. Find a Board Certified Plastic Surgeon who does both so you get the procedure most appropriate for you.

Sub pectoral dual plane implants give a convex or full upper pole, while sub-mammary implants give a fuller lower pole. It is the difference between a torpedo and a teardrop respectively. Sub-mammary implants do not do well if you have little or no overlying breast tissue, but remember that sub-pectoral dual plane placement involves some permanent damage to the lower attachment of the pectoral muscle to prevent the implants riding up. This is difficult to repair and can leave a contour irregularity in the very thin individual.

J. Brian Boyd, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 3 reviews

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Modest ptosis best treated by a silicone gel implant on top of the muscle.

+2

The photo shows modest ptosis of the breasts where the areola is situated a bit lower than preferred.  Even a modest augmentation will make the breasts look as though they have had a "lift" but without the usual scars.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 10 reviews

Dual plane breast augmentation for most

+2

Submuscular breast augmentation is always 'dual plane' as the chest muscle will only cover the upper half of the implant, and the lower portion is subglandular. The issue is simply anatomy. Why submuscular rather than subglandular? The submuscular placement is used to reduce the 'show through' of the implant, and reduce capsular contracture. If bodybuilding is in your future however, muscular distortion might make you unhappy and indicate a smaller subglandular gel as the best option.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 30 reviews

Sub muscular (Dual plane) or Subglandular Positioning of Breast Implants for Athlete?

+2

Dual plane breast augmentation refers to breast implant positioning in the sub muscular ( pectoralis major)  positioned superiorly and the sub glandular position inferiorly.  This is the breast implant position used by the majority of plastic surgeons today and what I would suggest in your case.

I think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).



The submuscular positioning  also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.
 I do not think that you will experience a loss of strength or flexibility after breast augmentation,  regardless of the location of breast implant placement. However, as you may know, sub muscular (dual plane) breast implant positioning does have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle).
 Again, I think the advantages of sub muscular (dual plane) breast implant placement far outweigh the  potential disadvantages associated with breast implants  placements of glandular position,  no matter how active the patient.
I hope this (and the attached link) helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 781 reviews

Which approach for breast augmentation?

+2

Thanks for the photos, which do demonstrate some ptosis. You should discuss your concerns with your plastic surgeon and then choose together the best approach for your situation. There are pros and cons of each operation you mentioned and you should carefully consider all these before proceeding. Best wishes.

Aldo Guerra, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 136 reviews

Implant position and the muscle

+2

The nomenclature is never as clear as it should be. Subglandular implants are, as described, under the breast and above the muscle. 

Dual plane, by most definitions covers what almost all surgeons do when they place submuscular implants. The implants are typically under the pectoralis  muscle only, and this covers the top 50-60% of the implant. The lower part of the implant is in the same position as a subglandular implant, hence the term dual plane.

Some use the term dual plane to  describe placing a submuscular implant and then also lifting the breast off the pectoralis muscle. Some feel this can avoid a lift in a patient with a "borderline" need for one. 

By in large the advantage of under the muscle is more coverage of the implant, a more natural look at rest,  fewer capsular contractures, and fewer ripples.  The disadvantage is "animation" or movement of the breast with pectoralis flexing, which tends to flatten the implant and causes the movement. 

Most US surgeons prefer submuscular (or dual plane) positioning for the majority of patients. The advantages of submuscular placement are less for women with more native breast tissue and who have chosen smaller implants. Women who do body building are less tolerant of animation. 

Be sure also to discuss the pros and cons of a breast lift with your surgeon. The advantages to the overall appearance may be more significant than are the disadvantages of the added scar.

Thanks, and best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 32 reviews

Fitness and Breast Implants

+1

    In most patients the submuscular approach produces the most camouflage for the implant.  Dual plane (dissecting above and below the muscle) does not alter the position of the implant under the muscle and does little to alter anything else.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 230 reviews

Why Do Some People Opt for DUAL Plane Placement?

+1

Subglandular placement of implants would, in light of your thinner tissue, show a more prominent upper implant edge and potential implant wrinkling in the upper pole. Few if any surgeons are doing complete submuscular implant placement (where, in addition to the pectoralis muscle coverage above, the serratus muscle and rectus abdominis muscle fascia inferiorly are raised for lower pole coverage.  Almost all "submuscular" placement is actaully subpectoral, and thus the implant is under the muscle in its superior portion, which is where it is needed, and under the breast parenchyma inferiorly, so essentially a dual plane position. However, dual plane technique nowadays also refers to some possible release of the attachments of the pectoralis to the overlying breast tissue, usually in small increments, depending on the patient's anatomy.  This can be helpful in allowing the implant to better fill out the lower pole in a patient with a loose lower pole, a constricted lower pole, or borderline ptosis. Since your photos do show some mild ptosis, you have a better chance of avoiding a breast lift if a dual plane technique with some of this described pectoralis release is performed so that the implant can "expand" into the lower part of your breast.

Robert M. Grenley, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 71 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.