I am doing homework, I see over the muscle (subglandular?) under the muscle (submuscular?) and was curious what the dual-plane is and when it is used. Thank you
What is the Dual Plane Method for Breast Augmentation or Breast Implants?
Doctor Answers 27
Breast Augmentation - Dual Plane
Most patients and even surgeons don't really know what is meant by " dual plane ". The simple way to think of it is yes, that implant is under the pectoral muscle up top and below the breast tissue on the bottom. Otherwise known as partially under the muscle. What is actually meant by " dual plane " is that in addition to making the pocket in this location dissection is also performed above the muscle. This plane of dissection is taken up for several centimers and it's purpose is to loosen the muscle from the overlying breast tissue. This technique is supposed to be useful for patients who have slightly droopy breasts where the muscle would restrict the expansion of the overlying droopy breast tissue in an adequate fashion. There are other methods of loosening this breast tissue besides the dual plane technique, but really it is only useful for this specific subset of patients. Most patients don't even need it.
Bottom line is you need to go to someone that does good work. Look at photos ask for a referral from a friend. Asking a surgeon whether or not they do " dual plane " is silly and a waste of time in my opinion. Because really most surgeons haven't read the article so they don't know what it really means. They just assume, as I used to, that it means under the pectoralis muscle.
The question to ask is do you go under the muscle or over the muscle, meaning the pectoralis muscle only. I don't know anyone that does " completely under " the muscle which involves lifting other small muscles.
The "Dual Plane" plane, sub pectoral breast augmentation for tubular/constricted breasts
As Dr. Kim has quite rightly pointed out, that the Dual plane technique involves creating a generous pocket under the pectoralis major muscle while, curiously, separating the upper surface of the pectoralis major muscle from the overlying breast tissue for a few inches. What one ends up with is a loose pectoralis major muscle that covers the superior aspect of the implant similar to an "apron". In this way, the pectoralis major muscle, during the postoperative period of healing, is allowed to find and heal in its own natural resting position relative to the overlying breast tissue.
This technique provides a number of advantages over traditional "under the muscle"/sub pectoral techniques alone.
The first is that this technique allows minimization of flexion/contraction deformity when patients flex their pec muscles while their implants are in the "under the muscle" position.
A second advantage of the "dual plane" technique is realized when a patient has a constricted breast deformity whereby the distance from the lower edge of the areola to the lower breast crease is under 4 cm and their nipple is pointing downwards as a result. This could be part of a tubular breast deformity as well. By performing a dual plane technique in these cases, one can benefit from both the sub pectoral/ "under the muscle" position while having the lower pole of the breast expand maximally to accommodate the breast implant itself. In this way, the implant can sit in its proper position relative to the overlying breast, imparting the most natural result possible in these otherwise difficult cases.
The third advantage was pointed out by one of the other doctors in answering this question. The dual plane technique is appropriate for those breasts that are elongated and "droopy" after children and breast feeding. By fully releasing the muscle and allowing it to act as an apron, the implant can sit in its proper position behind the bulk of the breast (in the standing position) thereby avoiding a high-riding breast implant in which the breast tissue seems to just hang like a "double chin" off the implant itself. However, though the dual plane technique provides a very natural result in these cases, the patient may feel that they are now more droopy and have a "rock-in-a-sock" appearance to their breasts. A breast lift or mastopexy should be performed at the same time if the patient is amenable to the extra scarring.
Let me clarify some terminology that many plastic surgeons themselves misuse.
- Submuscular = the implant is COMPLETELY under the muscle with no release of the muscle (rarely done).
- Subpectoral = the implant is placed under the pectoralis major muscle, with the inferior edge of the muscle released so that the lower portion of the implant is covered by gland. This is what most people refer to as "submuscular"; however, they are technically incorrect. A classical subpectoral placement is the same as a Dual Plane I.
- Dual Plane = a form of subpectoral implantation with varying degrees of muscle release/separation from the gland in order to vary the amount of muscle/gland coverage ratio.
It may be semantics, but semantics are important. In summary, Dual Plane is a form of under the muscle or subpectoral placement.
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Dual Plane Breast Augmentation
Dual Plane Augmentation
The dual plane technique incorporates some of the advantages of both the sub glandular and sub muscular techniques while minimizing some of their limitations in the proper setting. When the breast is firm and the nipple areola is in the proper position well above the infra mammary crease then a sub muscular placement is indicated . In the past when there was laxity to the breast tissue envelope and a sub muscular placement was utilized, sometimes the breast would literally fall off the protheses creating pseudo ptosis or a "snoopy nose " appearance which was not ideal.. When the implant is placed sub glandular in these cases this can be avoided.,but over time the implant may become palpable, particularly saline implants. It takes on a round unnatural appearance. The dual plane technique where the top half of the implant is beneath the pectoral muscle and the lower half below the breast better fills the volume with less chance of feeling the implant. It also gives slight elevation to the NAC which sometimes avoids the need for a lift. It is particularly well suited when the lower pole is under developed or tight and the distance from the NAC is short, such as in tubular breast cases. This diminishing a the chance of developing a " double bubble". Many plastic surgeons including myself use some variation in most cases since the result appears more natural.
Dual Plane Augmentation Explained
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.
Dual plane breast augmentation
Dual plane is very common because it provides greater coverage. It is also better supported, slowing the rate of sagging.
Dual plane augmentation
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 subpectoral (as the inferior edge is released) or dual plane implants. In those women who have lost weight. The breasts have lost volume and skin has lost elasticity, and as such cannot bear the weight of the implant.
The Dual Plane Breast Augmentation..... What is it Really?
This term is often misused and misunderstood! This term can be used referring to a position or a technique. It is often used interchangeably with the term subpectoral or partially submuscular, but this term also refers to a procedure.
The true definition of the procedure, Dual Plane of Dissection was given by Dr David Kim from Beverly Hills, originally described by Dr Tebbetts. So, if you are slightly droopy and your surgeon suggested a Dual Plane dissection, it might be the best option for you.
But, be careful if you shop around, obviously we don't all use that term in the same way! The other way the term Dual Plane is used is in referring to position. The Dual Plane Position refers to the implant being under the Pectoralis muscle superiorly and medially, but under the breast tissue inferiorly and laterally. I believe this was originally described by Dr Spear.
Maybe a little TMI....?
Dual Plane Breast Augmentation
The term “dual plane” is used to describe an operation when the implant is placed beneath the pectoralis major muscle superiorly but lies directly under the breast tissue inferiorly. This technique requires dissection in both planes and is best for thin patients with moderate amounts of ptosis (i.e. drooping of the breasts) that would be difficult to correct with subpectoral or subglandular implant placement alone.