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

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


Submuscular = the implant is COMPLETELY under the muscle with no release of the muscle (rarely done).

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.

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.

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.

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.

Hi there,
While I cannot speak for all of the surgeons who do not perform the dual plane procedure (I do), I would say that the most likely reasons any particular surgeon does not offer this technique are because they either:

Never learned the technique; and/or
They are experienced in an alternative which gives them the results they want for their patients (in other words, if there is no problem in their outcomes, they may not feel it necessary to learn a new procedure).

One of the beautiful things about plastic surgery is that any particular problem might be approached in multiple different ways, with equal success, depending on the details of the patient's anatomy and goals. I hope that helps.

I prefer to use a dual plane, partial retropectoral technique for most of my breast augmenation patients because, in my hands, I feel it offers the nicest, most natural results.  I feel it offers benefits of both the submuscular technique and subglandular technique.
 

Dwmensik,
There are several ways to do breast implants. Every year at every meeting all the experts fight/debate about the best way. There is no "best way" that fits every patients body. You should be more interested in a surgeon that will customize your surgery for your body. Good luck with your surgery.

An under muscle implant is always a dual plane implant. The pectoralis muscle is a big triangle. At least 1/2 of the implant sticks out from the edge of that muscle -- it's under muscle for part of it, but about half has no muscle coverage. 

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.

It is quite frustrating that common surgical procedures can become marketing terms, making the non-physician believe they are something new and essential.  Dual plane augmentations have been done for a long time.  We just didn't know the technique was a nuance the patient actually needed to know about---it's kind of like wanting to know what kind of knot your surgeon chooses to tie her suture.  It doesn't make a difference to you regarding your final result, it's just your surgeon's preference.

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..