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 16

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

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.

Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Dual Plane Breast Augmentation

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.

David E. Kim, MD
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 97 reviews

Dual plane most common.

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 E. Genter, MD, FACS
Abington Plastic Surgeon
4.3 out of 5 stars 16 reviews

What plane for breast implant placement?

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 5 reviews

Dual plane breast augmentation for most

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 42 reviews

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

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 1,488 reviews

Which approach for breast augmentation?

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
4.9 out of 5 stars 201 reviews

Implant position and the muscle

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
4.6 out of 5 stars 45 reviews

Why do some people opt for dual plane placement? Which is best for me?

Judging by your photographs and your description appears that you would be a good candidate for a dual plane breast augmentation.When a patient presents with a small amount of breast ptosis (sag) a dual plane breast augmentation is a very effective technique to help avoid the need for a breast lift and still allow the implant to be placed under the muscle. When an implant is placed under the muscle and the overlying breast has some degree of sag the muscle will hold the implant back and not allow it to fill the loose tissue at the bottom of the breast The word dual means two and the word plane refers to the natural separation between two layers of tissue. In the breast there is a natural separation between the breast tissue and the underlying muscle. During a dual plane augmentation the breast tissue in the lower part of the breast is separated from the underlying muscle. The muscle is then released along its entire attachment at the bottom of the breast. The muscle then moves upward like a window shade toward the nipple. With the restriction of the muscle in the lower part of the breast removed the implant is then allowed to fill the loose sagging part of the lower breast. This is a very effective technique to help prevent the need for a breast lift in a patient with a small amount of sag and still have a benefits of an implant placed under the muscle. You should look forward to a nice result. Good luck

John J. Edney, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 112 reviews

Selection of Dual Plane, Submuscular, Subglandular Breast Aug

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.

In your particular case, I would focus and spend the majority of my energies on selecting the best plastic surgeon for the job rather than telling him/her what to do. Rather it is their job to guide you through this decision making process. See the below link on how to do this.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 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.