Can You Perform a Dual Plane Breast Implant Procedure Through a Nipple Incision?

I had implants in Shanghai. I can feel the edges on one side and bottom and they are slightly uneven, but other than that I was pretty happy. I told my family Dr what I had done and he laughed and said it could not be under the muscle if the incision is around the nipple. Have I been misled? I was told that the surgeon used a dual plane procedure. Now I am a little concerned - should I be feeling the implant edge so easily? I can also feel a bubble under the side of my nipple!

Doctor Answers (17)

Can You Perform a Dual Plane Breast Implant Procedure Through a Nipple Incision?

+1

Your doctor is mistaken. Submuscular, dual plane, and prepectoral (premuscular) positions can all be performed though the periareolar incision. However, if your implants are soft and movable, I would not re-operate on them because you can feel the edge of one of the implants, particularly if you are pretty happy with them. All surgical procedures do carry some risk. If they must be replaced in the future for any reason, you can have them placed behind the muscle through the periareolar incisionat that time. The bubble behind the areolar is either a wrinkle in a silicone implant or the valve or wrinkle in a saline implant. Wrinkles are less likely to be felt behind the muscle.


Savannah Plastic Surgeon
5.0 out of 5 stars 33 reviews

Dual Plane Breast Augmentation and Periareolar Approach

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A "dual plane approach" simply means that a portion of the breast implant is covered by the muscle, and a portion is covered by the breast glandular tissue. This can be achieved through a peri-areolar or infra-mammary approach. With regard to the "edges of the implant" you are feeling,  I would recommend that you see a plastic surgeon to determine if what you are feeling is truly the implant, and whether this can be improved.

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 16 reviews

Dual plane breast implant placement can be done through peri-areolar approach

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Your left breast looks a bit 'flat' in the lower pole, as if you had a mild constricted breast shape on that side. Tough to say without pre-op photos. I don't think that doing from sub-glandular to dual-plane placement is going to help your breast shaping. It may help soften the palpable edges of the implant. 

Dual plane placement through a peri-areolar incision is commonly done.

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.5 out of 5 stars 34 reviews

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Yes it can

+1

Implants can definitely be placed under the muscle from the periareolar incision (like you have).  It looks to me that the fold below your breast is at a different height on each side - this is likely something that existed beforehand.  Feeling the rippling at the bottom or side is more common with saline than silicone so you may want to change to silicone if you have saline.  You will always feel your implant on the bottom where the muscle doesn't fully cover the implant, though.  Good luck!

Bivik Rajnikant Shah, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 8 reviews

Dual plane breast augmentation

+1

Yes, it is possible to do a dual plane breast augmentation through the nipple. A dual plane technique is by definition having an implant that is both above and below the muscle at the same time. When the pectoralis muscle is detached from the inferior border of the breast, the muscle retracts superiorly. This means that when the implant is placed in the breast pocket, the  upper part of the implant is covered by muscle and the lower part is covered by breast tissue. 

Wilberto Cortes, MD
Houston Plastic Surgeon
4.5 out of 5 stars 302 reviews

Dual plane and peri-areolar approach

+1

Hello, Subpectoral, subglandular, and subfascial placement of the implant can be achieved through inframmary, periareolar, and transaxillary incisions. Dual plane is essentially a subpectoral position. All the best, Dr Remus Repta 

Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 89 reviews

Dual plane through th areola

+1

Funny!  I do that all the time. It is very easy to do it through the areola.  It can be doen through other approaches as well.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Worries about placement of breast implants

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Your family doctor should be embarassed.  Not only was he wrong, but it was inappropriate to laugh at the work of another physician and alarm you.  He should have referred you to a board certified plastic surgeon in your area for accurate evaluation and information.  Many, many surgeons do subpectoral or dual plane breast augmentations through peri-areolar incisions.  The muscle only covers the upper inner half of the implant and so your implants can be more easily felt along the sides and lower aspects of your breasts.  Saline implants are easier to feel than silicone.  The bubble you feel next to your nipple may be the valve used to fill a saline implant or a fold in the surface of the implant.  This is not uncommon and nothing to worry about.  Your left implant is a little higher than the right which is easy enough to fix if it bothers you.  There is every reason to believe that your breast augmentations were done as your surgeon said they were.

Lori H. Saltz, MD
San Diego Plastic Surgeon
4.5 out of 5 stars 11 reviews

Can You Perform a Dual Plane Breast Implant Procedure Through a Nipple Incision?

+1

Yes it can. Your issue is a poorly preformed augmentation with very little attention to detail and symmetry. I base this on your posted photo. Seek a second opinion.

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

Fixing breast asymmetry

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Your posted photo shows asymmetry with the left nipple further from the midline than the right, the left breast slightly smaller than the right and the fold under the left breast slightly higher than the right. This is what you call uneven. I suspect these were present before surgery and you would be happier now if they had been adjusted during surgery to make you more symmetric afterward. Sometimes asymmetry is very slight before surgery and not noticed unless the surgeon takes the time to measure everything with a tape measure. When the implants are placed they can magnify the asymmetry so it is more easily noticed even without a tape measure. This may be what happened to you.

I think your family doctor's behaviour was unprofessional and uncalled for. The incorrect comments and laughter only served to increase your anxiety as the results are not that bad. My first recommendation is to find a new family doctor.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

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.