Why Don't All Surgeons Offer Dual Plane Placement of the Breast Implants?

Doctor Answers 18

Dual Plane

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Let me clarify some terminology that many plastic surgeons themselves misuse.

  1. Submuscular = the implant is COMPLETELY under the muscle with no release of the muscle (rarely done).
  2. Subpectoral = the implant is placed under the pectoralis major muscle, with the inferior edge of the muscle released so that the lower portion of the implant is covered by gland.  This is what most people refer to as "submuscular"; however, they are technically incorrect. A classical subpectoral placement is the same as a Dual Plane I.
  3. Dual Plane = a form of subpectoral implantation with varying degrees of muscle release/separation from the gland in order to vary the amount of muscle/gland coverage ratio.

It may be semantics, but semantics are important.  In summary, Dual Plane is a form of under the muscle or subpectoral placement, and it is NOT new.  It has been done by most plastic surgeons for a a very long time.

Toronto Plastic Surgeon
5.0 out of 5 stars 35 reviews

A patient really can't differentiate between the procedures

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Despite all the information available on the internet, it really isn't a good idea for a patient to become fixated on a "named" operation. There are many ways to do an excellent breast augmentation, facelift, tummy tuck etc. No one procedure is right for every patient. What you should focus on is finding the best surgeon who can offer multiple ways of doing a procedure and can help determine what version is going to give you your own best result.

Dual plane breast augmentation offers many advantages and few risks

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Honestly, I think most doctors who do breast augmentation do the dual plane procedure, and always have, but have never called it dual plane.

In other words, dual plane augmentation mammaplasty is primarily a marketing term. The standard modern teaching and text books all recommend that the lower insertions of the pectoralis muscle be detached to allow the bottom of the implant to be in the subcutaneous or subglandular position, and the upper pole to be beneath the muscle.

This does allow an upward rotation or lift of the breast, which is very helpful in breasts that have a little sag.

I have for many years used a technique which can more accurately be described as dual plane and which does help lift the breast.

I elevate the entire breast off of the underlying pectoralis muscle-essentially create a subglandular pocket. Then I do a subpectoral breast augmentation.

The breast which has been detached form the muscle then is able to move upward and redrape nicely over the submuscular implant. This operation, elevating 2 planes, the subglandular and subpectoral plane, really helps avoid the need for a breast lift in patients who have had sagging breasts following pregnancy.

See before and after pictures of my "dual plane" breast augmentation.

Dual plane breast augmentation is nothing special.

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Breast implant placement is a decision based on the anatomy of the patient, the type of implant chosen, and the biases of the surgeon.  "Dual plane" may sound like some procedure that has just emerged by it descibes only a very common type of augmentation.  Your surgeon should be able to perform all types of breast augmentation and have a good reason for recommending one over the other.

Dual Plane Breast Aug Technique is not "new"-only the terms are "new"

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Most plastic surgeons that have a large practice with a diverse experience in cosmetic breast surgery, i.e., breast augmentation,breast lift, breast augmentation with simultaneous breast lift, and breast reduction, are well trained in dual plane surgery of the breast.

The term "Dual Plane" is much newer than the actual techniques, and was recently "coined", but truly, most plastic surgeons are quite familiar and practice this technique. When patients ask me this question, I reassure them not only that I am familiar with, trained and practice the "dual plane" technique, but I also educate the patient in the different choices for implant placement and pocket dissection-emphasizing that the choice for "dual plane," submammary (on top of the pectoral muscle) or subpectoral (under the pectoral muscle) will be something I consider for each patient, based on their anatomy. Implants that are "subpectoral" are in fact, only partially covered by "muscle" as the pectoral muscle does not have the same shape, position, as the breast overlying it.

Therefore, any implant of any size or shape, placed "subpectoral" is covered by not only the pectoral muscle, but also be the breast and this is where the modern day term of "dual plane" was created, but in truth, the technique is "old". "Dual plane" is a term to recreate something that most experienced plastic surgeons have been doing for decades. All subpectoral implants are truly both under the pectoral muscle in the inner portion and upper portions of the breast where the muscle is anatomically present--and--- truly under the breast (submammary) in the outer and lower portions of the breast where there is no pectoral muscle.

I like to draw this anatomy for the patient so they understand exactly where the implant will be in relation to the muscle and breast and this will help explain what they see and feel following the breast surgery, so there is less room for confusion or mystery. I do all techniques and base my decision on what I hear as I listen to the patient, but most importantly, on what I obtain from my assessment of the patient's anatomy by physical examination and photography of the breast and chest in several postitions that help me to see as much as I can of the 3 dimentional aspect of the anatomy.

The operation is then customized to the patient's unique anatome to give the best result. The anatomy can be very different from one breast to the other in the same patient and certainly from one patient to another patient, so I warn patients to not rely too much on the "friends" opinions or experiences as everyone is unique!

Christine A. Petti, MD
Los Angeles Plastic Surgeon
4.3 out of 5 stars 23 reviews

This is a matter of semantics and less technique

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So first let's answer what a "dual plane" augmentation is. This is a fancy term for a standard submuscular agumentation. The pectoralis muscle does not cover the entire implant and the lower half to third is under the skin. that is all that a dual plane is.

I like to assess the patient and see what would look best in them and then where should the implant go. With the silicone implants back on the market, I have been happiest with sub-glandular silicone - especially if the patient has had children and has good skin and gland coverage. For tiny skinny women, sub muscular or dual plane works well, especially if they are having saline implants put in.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Dual Plane breast augmentation

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An implant placed above the muscle is referred to as ‘sub-mammary’ (or ‘sub-glandular’), while an implant placed under the muscle is referred to as ‘sub-pectoral’ (or ‘sub-muscular’).The muscle in question is the pectoralis major.The term ‘sub-pectoral’ or ‘sub-muscular’ is somewhat misleading, as implants placed under the pec major are only partially covered by the muscle.The pec major covers the upper/medial half of the breast area, so a ‘sub-pectoral’ implant is truly subpectoral only in the upper and medial aspect of the augmented breast, while the lower and lateral aspect of the implant is actually in a sub-mammary position.Because sub-pectoral implants are, in reality, both sub-pectoral (upper/medial breast) and sub-mammary (lower/lateral breast), this placement has more recently been referred to as a ‘dual plane’ approach to breast augmentation.

There is also ‘total submuscular’ implant placement, in which the implant is positioned behind the pec major and the serratus anterior muscle, so that the entire implant surface is covered by muscle tissue.This is not commonly done for cosmetic breast augmentations, but has been used for breast reconstruction using breast implants.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

What dual plane really means - Breast Augmentation

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Problem is most patients and surgeons don't really know what the term dual plane means. As I mentioned in another post , a pocket is created beneath the pectoralis muscle , the muscle covers the top part of the implant and the bottom half of the implant is covered by your breast. Then there is an additional plane of dissection above the muscle for several centimeters. Thus " dual plane ". 

This procedure has been described to be used in patients that have somewhat droopy breasts. The idea is that by dissecting in a plane above the muscle the implant will not be as restricted by the muscle and  be able to fill out the overlying loose breast tissue.  There are other ways besides dual plane to free the muscle in this subset of patients.

But as mentioned in several of the answers below to go in and ask if your surgeon does dual plane is silly. Just ask either above or below the muscle. Most real plastic surgeons will place the implants under the muscle, meaning the pectoralis muscle.

Because honestly is someone telling you they use dual plane going to be the deciding factor in choosing a surgeon. I hope not. The number one deciding factor should be what kind of work does the doctor do. Best thing you can do is go to a board certified plastic surgeon and see what there work looks like with photos.

David E. Kim, MD
Beverly Hills Plastic Surgeon
4.6 out of 5 stars 106 reviews

Dual plane breast augmentation

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Funny, I was doing dual plane breast augmentation before it was named such.  There really is no one right way of doing it.  Some go over the muscle, some go under, some release the gland from the underlying muscle a bit to go under, etc.. 

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

If you're searching for a specific technique, you may be looking at the wrong factors

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Your question is simple and many other surgeons have posted an answer. I think most surgeons in practice do such a procedure, with variations.

The use of "dual plane" placement of breast implants is not as important a decision as many, many other factors that a patient and surgeon should discuss during the consultation process. If you are searching for a specific technique, you may be looking at the wrong factors.

Seek an experienced, board-certified plastic surgeon through a number of recommendations and discuss your goals with him or her. Ask how they would try to help you reach those goals. If your research has lead you to several good candidates who vary only in use of "dual plane," you have really done a lot of quality consultations.

Sutton Graham II, MD
Greenville Plastic Surgeon

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.