What are the cons of dual plane implants?

Some surgeons use the dual plane technique in an effort to avoid a breast lift. Dual plane is effective in mild (grade I) ptosis but not in more severe cases (grade II or III) where a lift or mastopexy is necessary.

All of my 7000 breast augmentation patients have had dual plane with great results and no problems. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. You should also be aware that results of surgery can change in the future with significant weight change and/or stretching of skin from the milk of pregnancy. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame

Your surgeon was right about one thing, which is that dual plane involves cutting the attachment of the pectoral muscle, which often leads to animation deformity. An alternative that preserves muscle coverage over the upper part of the implant is the split muscle method.

Hello, thank you for your question. Dual plane refers to breast implant positioning in the sub muscular ( pectoralis major) positioned superiorly and the sub glandular position inferiorly. 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. However, the sub muscular (dual plane) breast implant positioning does have the potential downside of animation deformity.

First, 'dual plane' is the same as 'sub-pectoral' or 'partial sub-muscular'. Although there are a few surgeons who claim to do a complete submuscular placement (which requires the painful surgical process of elevating pec minor, serratus, and six pack muscle off of your ribs), good data shows that it does not confer an advantage to dual plane. All other alternatives are over the pec major muscle, either subfascial or subglandular. Whether dual plane or over the muscle, they both have complications, with the exception of the risk being greater when placed over the muscle: rippling, implant visibility, capsular contracture, tissue atrophy, dropout, etc. The only downside to dual plane is dynamic movement of the implant with muscular contraction, a minor to non-existent issue in women who get properly sized implants.

Unfortunately, you have not provided photographs or told us your bra size. However, you desire going big but that is subjective. Bigger implants weigh more and will more likely have complications such as descent, lateral displacement and possible double bubble. The dual plane technique irreversibly cuts the lower portion of the pectoralis major muscle, which results in loss of strength of the muscle and cannot be repaired. I recommend you consider your breast size, your breast size goals and fat transfer as an alternative. Implants are not lifetime devices. 8% fail within the first year and 30% fail within six years. Fat transfers are permanent and incorporated into the body.

Best Wishes,

Gary Horndeski, M.D.

To me dual plane and sun muscular are the same thing. In submuscular only the upper inner part is covered by muscle. In the lower lateral part the is no muscle to cover the implant. Im sure you can have submuscular Implants. Different surgeons have different notions of these terms, but to me they are the same and I almost sissy’s go submuscular.

Thank you for sharing your question. There are not many cons of a dual plane procedure compared to a sub glandular implant placement but things to consider would be animation deformity and a longer, slightly more painful, recovery. Hope this helps.

Dear Sociable6922,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Most breast augmentations these days are done via dual plane. It involves lifting the pec muscle and placing the upper portion of the implant underneath that portion of muscle. There can be what is called animation deformity - where flexing the muscle causes movement of the implant. This doesn't happen as much when surgery is done very carefully. As always, be sure to research who performs your surgery to ensure the best likelihood of a positive result.