Split Muscle vs Dual Plane? (Photo)

I've breastfed 4 children and am done having children. I'm getting ready, 6 days pre-op, to have round silicone implants placed subpectoraly. I am very active, athletic, and strong. I am concerned about animation deformity. Is split muscle technique really the answer to that? Does it significantly diet from the disk plane technique in regards to animation deformity? What are the pros and cons of split muscle deformity.

Doctor Answers 7

Split Muscle versus Dual Plane?

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Your photo indicates that your tissues are quite thin so it clearly makes sense to place under the pectoralis major muscle to avoid visible upper pole rippling and an unnatural superior pole contour. Unfortunately, as you are aware, implants in the sub pectoral position are prone to the problem of animation deformity, particularly in the athletic individual. The split muscle technique has been shown to minimize the deformity, although it does not usually completely eliminate it, and it makes for a more complex surgery with some increased risks of complications. 

Animation deformity can significantly vary according to the type, size, and style of implant, the type of implant surface, the way in which the surgery is done, and probably most important, your specific muscle anatomy. So some individuals are much more predisposed to have this problem than others, in particular patients who have a muscle origin that is located higher on the chest wall will tend to develop a more severe deformity. A smooth surface round large or high profile saline implant on someone with a high muscle position would be a situation in which that person would develop a more severe form of this problem. This is because the smooth surface implant slides around easily on the chest wall and the less compressible high profile implant is more prone to displacement by the muscle. On the other hand, a lower profile, smaller, silicone gel implant with a textured surface will be much less predisposed to the muscular displacement known as animation deformity.

Given that you tissues are quite thin, you would also be a good candidate for an anatomic or teardrop shaped implant which would give you a more natural appearing result. All shaped implants have a textured surface so that they adhere to your tissues to prevent rotation of the implant, but this also has the additional benefit of limiting motion of the implant which minimizes animation deformity. Also, the gradual slope of the upper portion of the implant will be less predisposed to the mechanical forces of muscle contraction again minimizing animation problems. I have found that the Sientra teardrop shaped gel implants are an excellent choice for minimizing the problem of animation changes and allow one to avoid the more radical surgical approaches like the split muscle technique. I would not use a smooth surface implant in your situation because it will predispose you to a more severe expression of animation deformity, and very careful dissection of the implant pocket must be done to preserve as much as possible the lower and more medial attachments of the muscle. 

The notion that an endoscopic approach is technologically more advanced is complete nonsense. An endoscope is simply another tool with which to perform surgery. The outcome of the operation has far more to do with the skill, experience, thoughtful planning, and technical execution of the procedure rather than any particular type of instrument that is used. A transaxillary approach will not prevent the problem, and I personally find that an inframmary incision provides the best visualization and access for performing the careful and precise dissection of the implant pocket required in this type of situation.

Dual plane

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A dual plane is usually the way to go when you are thin. This will allow muscle coverage of the upper pole.  Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Dual Plane

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Hi C Momma,
I suppose you will receive a lot of different answers.  See the answer two down by Dr. Rigano, as I agree also you would benefit from a dual plane.  Thanks also for your photo.  I believe you will find the references below to be helpful.  All the best, Dr. Joe

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Dual plane

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Your tissues are thin and a dual plane will look better,stay soft longer. Muscle animation occurs with maximal pectoral contraction which happens when working out. You will have a higher chance of capsule if the implant is under the breast.

William C. Rigano, MD
Dayton Plastic Surgeon

Semantics can be confusing...

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Thank you for the question and picture.
There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. I will try to outline some of the differences here; you may find the attached link helpful as well.
I think it is in the best interests of most patients (including you based on your picture) seeking breast augmentation surgery to have implants placed in the “dual plane” or 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 breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.
On the other hand (as you mentioned), sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in the sub muscular position.
Best wishes for an outcome you will be pleased with.

Animation deformity

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First off, you have what appears to be pretty thin tissue so placing an implant on top of the muscle would likely be a poor choice with respect to seeing the superior pole of the implant. Therefore, from a camouflage point of view, sub-muscular placement is a must. With sub-muscular placement, there is always some degree of animation deformity no matter what approach is used. The key to minimizing the animation deformity is to dissect the muscle a bit more aggressively so less of the implant is covered by muscle. Discuss these concerns with your surgeon and if your concerns are not adequately addressed, another opinion may be in order. Hope this helps, good luck!

Marcel Daniels, MD
Long Beach Plastic Surgeon

Dual plane

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The most sophisticated approach to breast augmentation is through the armpit with a surgical camera (transaxillary endoscopic). Using this modern approach the space can be crafted under direct vision, with virtually no bleeding and no postoperative bruising. Most importantly, the shape of the breast is meticulously created. This is the dual plane technique.  If done properly you will not have an animation deformity.  Split muscle is the periareolar technique. If done correctly you won't get an animation deformity.  If done poorly you will.  The older methods of insertion are technologically less advanced. 

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.