What is the difference between dual plane & fully under muscle? Do doctors typically tape breast lift scars?

If you are confused - don't worry!  I lecture about this frequently and it is a source of confusion for even some plastic surgeons.  The answer has more detail than any patient would want, but i don't know how to describe it more succinctly.On one extreme is total sub muscular, meaning the entire implant is behind muscle. To do this the implant is put behind the pectorals major muscle (the pec) as well as behind the serratus anterior muscle, which is on the lower outer part of the chest.  This is a technique mostly used for reconstruction after mastectomy.  It is more painful, has more bleeding, and the shape lacks a "crisp" crease under the breast than other techniques.The other extreme is totally in front of the muscle, known as sub glandular or sub mammary.  You can also put it under the thin fascia that covers he muscle, and that is called sub facial, but it is inconsequentially different than sub glandular.When surgeons place implants "behind the muscle," they invariably mean behind only the pec.  But the pec can cover 40-60% of the implant.  Even if none of the muscle is divided/cut/released, only the inner and upper part can be covered.  f the surgeon does not cut any muscle fibers, the proper terminology is "partial retropectoral."But most of the time the surgeon has to divide some of the fibers of the muscle at the bottom crease of the breast in order to create a crisp fold, reduce motion of the implant with contraction of the muscle, allow expansion and fill of the lower breast, and prevent the implant from "riding high."If that muscle is merely divided it is called Dual Plane I. That is the way most augmentation are done.  However if the lower pole of the breast is sagging off of the muscle, the muscle can be released from the overlying breast.  Thiallows the muscle to slide up.  This reduces muscle coverage, but it means there is no muscle between the implant and the breast tissue in the lower part of the breast.  This allows better expansion and fill of an empty breast.  It is equally as important for a very tight and "constricted" lower pole in which you similarly need the implant to expand the lower breast. It is called Dual Plane II when the muscle is released to the lower border of the areola, and Dual Plane III when it is released to the upper border of the areola.So the important part to know is that most surgeons most of the time are doing what is properly known as a Dual Plane I.  The importance of the "dual plane concept" is that the surgeon recognizes the pros and cons of covering various parts of the implant in each patient and controls the muscle to create the coverage the need where they want it.  The idea is to blend the advantages of being both in front and behind the muscle, while minimizing the disadvantages of being in front and behind.I hope this was helpful.  

In most cases, the implant ends up being only partially under the muscle, only in the upper part.  Taping the breast afterwards is done by some surgeons for various reasons, including those you mention.

When we refer to implants as being placed under the muscle, that is just to simplify the choices to above or under. Actually under the muscle is dual plane, not fully under the muscle. We never put implants fully under the muscle, because the muscle origins have to be released from their rib insertions near the inframammary fold so the implant will have room to sit without constriction or being pushed up away from the fold.Dual plane I is just release of the muscle, so the muscle goes up and the implant is partially covered by the muscle and mostly by the lower breast. Dual plane II, just means that the muscle is also separated from the overlying breast tissue by a few centimeters, sometimes as high as the areola, so more of the implant is under the breast, and less is under the muscle. This is helpful if the breast is a bit droopy because it allows the implant to expand the lower breast more and lift it up.I usually put steri-strips on the breast lift scars around the areola and leave the on for 2-3 weeks.  This probably does nothing for scar quality long-term, but helps splint the incision to get good healing initially.

44Wendall,Dual plane augmentation is very common. Its rare that anyone puts an implant entirely under the muscle because it tends to stay too high. Scar widening can happen irregardless of whether you tape your incisions or not. I would follow up with your plastic surgeon to discuss what is happening.I hope this was helpful,Dr. Daniel BarrettPlastic and Reconstructive SurgeryBeverly Hills, CA

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.

Dr Nichter has given a good explanation of dual plane but as a revision patient a full examination is really needed to give you the best advice for further surgeryDr Corbin