What Are the Advantages/disadvantages to a Dual Plane Technique Vs. Completely Under the Muscle for Breast Augmentation?

Doctor Answers (16)

What Are the Advantages/disadvantages to a Dual Plane Technique Vs. Completely Under the Muscle for Breast Augmentation?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Almost all women need the dual plane approach because the pec sits up a bit too high in most women. It needs to be released to allow the implant to drop down just a bit. If not, the implants sit just a bit high and the nipple too low. You can see many examples of this on this site. The only time I consistently leave full muscle coverage of the implant is when I am doing a lift as well. Then I can bring the breast tissue up to the implant!


Phoenix Plastic Surgeon
5.0 out of 5 stars 20 reviews

Dual Plane Breast Aug Advantages

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
My best suggestion is to pick the best plastic surgeon rather than the procedure. It is their job to guide you through this process. See below link on how to select the best plastic surgeon for the job.
Here is some general information however on the dual plane technique. For cosmetic Breast Augmentation, the dual plane technique refers to the implant being partially beneath the pectoralis muscle. As the lower part of this muscle is above the lower lateral part of the breast most Subpectoral implants are in fact to a degree dual plane although erroneously often called total submuscular.
However, the degree of the implant is beneath the muscle on top and soft breast tissue below can be altered by making the submuscular pocket higher up the muscle leaving some of it below the implant below and some above. The advantage of this is to expand the lower pole of the breast if short or more often for mild drooping breast correction.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 55 reviews

Dual plane vs Complete Submuscular placement

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Dual plane breast augmentation simply means that the implant is placed partially under the muscle. Just the top portion of the implant is put under the chest muscle, while the rest of the implant is only under the glandular tissue. True sub muscular placement involves the implant being placed entirely under the muscle, and this is usually only done for breast reconstruction patients because of its related risks.

Dual plane is very common because it provides greater coverage. It is also better supported, slowing the rate of sagging.


Dual Plane breast implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
An implant placed above the muscle is referred to as ‘sub-mammary’ (or ‘sub-glandular’), while an implant placed under the muscle is referred to as ‘sub-pectoral’ (or ‘sub-muscular’).The muscle in question is the pectoralis major.The term ‘sub-pectoral’ or ‘sub-muscular’ is somewhat misleading, as implants placed under the pec major are only partially covered by the muscle.The pec major covers the upper/medial half of the breast area, so a ‘sub-pectoral’ implant is truly subpectoral only in the upper and medial aspect of the augmented breast, while the lower and lateral aspect of the implant is actually in a sub-mammary position.Because sub-pectoral implants are, in reality, both sub-pectoral (upper/medial breast) and sub-mammary (lower/lateral breast), this placement has more recently been referred to as a ‘dual plane’ approach to breast augmentation.

There is also ‘total submuscular’ implant placement, in which the implant is positioned behind the pec major and the serratus anterior muscle, so that the entire implant surface is covered by muscle tissue.This is not commonly done for cosmetic breast augmentations, but has been used for breast reconstruction using breast implants.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 45 reviews

Dual plane and submuscular

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your skin quality is the main determinant of location and so the best person to answer this question is your plastic surgeon. In my practice a majority of women get submuscular or dual plane implants and especially in those women who have lost weight. The skin has lost volume and elasticity and as such cannot bear the weight of the implant. In dual plane t implantis partly under te muscle a partly subglandular in the lower pole.

Dual plane is the procedure of choice.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Dual plan positioning of a breast implant allows for a natural appearance for an augmentation by allowing the implant to sit in the appropriate position on the chest wall. The pectoralis muscle is used for improved camouflage of an implant in a small breasted woman, to decrease capsular contracture rate, and to improve vascularity of the breast and nipple in cases of augmentation mastopexy. Unfortunately, the pectoralis major muscle does not always line up anatomically with the overlying breast and the resultant inframammary fold. By dividing the inferior attachments of the muscle and placing the implant where the breast is (rather than where the pectoralis is) the augmentation has a much more natural look.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 12 reviews

Dual Plane the procedure of choice...

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

as mentioned by my colleagues.  This technique allows for significant inferior releases of muscle and breast tissue so subglandular approaches are becoming less and less desired.  The advantages of having partial muscle coverage are well known and with the amount of release, my patients have very little muscle movement when the chest muscle is contracted.  I doubt anyone really does a total submuscular position anymore. 

Curtis Wong, MD
Redding Plastic Surgeon
4.5 out of 5 stars 17 reviews

Dual Plane Breast Augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Total submuscular augmentation is essentially obsolete at this point.  The vast majority of plastic surgeons use the dual plane technique for a much nicer result.

Michael Orseck, MD
Greenville Plastic Surgeon
5.0 out of 5 stars 50 reviews

True Total Submuscluar Placement Rare

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Today, the terms "Dual Plane" and "submuscular" are essentially interchangeable in breast augmentation surgery. The bottom of the pectoralis muscle sits above the bottom of the breast. Unless this is released, a breast implant will sit too high and the nipple will typically point downwards. Don't allow these terms to confuse you.

Lawrence Iteld, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 23 reviews

Total Submuscular Cover v. Dual Plane for Breast Implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Submuscular augmentation was introduced in the 80's as a method to decrease capsular contracture.  Originally it was thought that complete muscle cover was best.  The muscles used included the pectoralis and the serratus anterior.  Over time it was recognized that this technique pushed the implant too far laterally.  It is not used today.  The dual plane technique is now synonymous with a submuscular breast augmentation.  In this method the implant is under the pectoral muscle until the lower portion of the beast.  The second "plane" of the implant is beneath the breast gland.  The pectoral muscle is released from its attachment to the ribs.

Mary Lee Peters, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 94 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.