Does dual plane implant placement always require cut to the muscle?

Yes. In dual plane, the bottom edge of the pec muscle is cut. Depending on the amount of sag, the muscle can be disconnected from the bottom of the breast tissue to allow the implant to sit a little lower on the chest. This helps fill out the lower breast and make the areola look higher on the breast. Generally, the muscle is not separated from the breast tissue above the level of the nipple.

Technically dual plane means you dissect under the gland and the muscle. Therefore it is does require release of the muscle slip onto the rib periosteum. It is a great technique especially for patients with ptosis.

Thank you for sharing your question. Yes, dual plane placement always involves incising a small portion of the muscle. Hope this helps.

The definition of dual plane is the implant is above and below the muscle. This is only achieved by cutting the inferior edge of the muscle. Unfortunately, when the inferior edge of the muscle is cut, it can retract and the only thing holding up the inferior portion of the implant is the skin envelope, which can often times stretch and results in bottoming out. The dual plane technique can be avoided if a simultaneous lift is done. This will allow the nipple-areola complex to be higher and the implant can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Thank you for the question. Dual plane means that the implant is (to some degree) under the muscle, and that the pectoralis major muscle is (partially) cut. I hope this helps. I wish you the best of luck. Vasileios Vasilakis, MD. Double board-certified, fellowship-trained plastic surgeon, Houston. TX.

All dual plane implant placement requires some muscle division. The idea is that we need to place the implant where we want to create the final outcome. If the muscle is not divided, the muscle will push the implant to the sides and possibly up. This technique became popular in the 90's and has become the usual subpectoral technique today. The question is how much of the muscle is divided and where is the muscle divided. Some patients worry about resulting weakness, but this is usually not a major issue. By correctly dividing the muscle, we help reduce hyperdynamic implant movement which can be quite an issue in total muscle coverage. Talk to your surgeon about any concerns and they can help put all of this in perspective.

Dear Anon485745,
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

Yes. Dual-plane always includes the release of the pectoralis from its insertion along the lower part of the breast. Different dual-plane levels are based on how high the separation of glandular (breast) tissue from underlying pectoralis is performed. Your plastic surgeon should be able to tell you at the time of your consultation, what level of release you may require.

Thanks for the question. Dual plane implant placement always require cut to the muscle. It is the regular process of the procedure.