Submuscular vs. dual plane, which one releases more muscle?

Question

My implants are fully sub muscular according to my surgeon. They are riding very high and my tissue is sitting at the bottom. Can someone describe the difference between sub muscular and dual plane to me? Does one require more muscle release than the other? What would need to be done to be dual plane?

Daniel Barrett, MD · Answer

Dear Feelinglost16,
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

Martin Jugenburg, MD · Answer

Thank you for your questions! I’ll break this down clearly:

(1) Submuscular (fully under the muscle):
- The implant sits completely beneath the pectoralis major muscle.
- This can make the upper part of the breast feel firmer and cause the implant to ride a bit higher initially.
- Fully submuscular placement usually requires more muscle coverage, but less adjustment of the lower breast tissue.

(2) Dual plane:
- In a dual plane approach, the upper part of the implant is under the muscle, while the lower part is partially released from the muscle so it can sit more naturally with the breast tissue.
- This allows the implant to fill the lower pole better, reducing a high-riding appearance and giving a more natural slope, especially in patients with little breast tissue.
- Achieving dual plane requires releasing part of the lower edge of the pectoralis muscle so the implant can settle into the lower breast tissue.

Key difference:

- Fully submuscular  entire implant under muscle, often higher and firmer.

- Dual plane  upper implant under muscle, lower implant under breast tissue, which usually gives a softer, more natural look in the lower pole.

If your implants are riding high and your tissue is sitting lower, your surgeon may consider converting to a dual plane to allow the implant to drop into a more natural position. This involves a minor revision surgery where the lower muscle is released while keeping the upper coverage intact.

John L. Burns Jr., MD · Answer

By creating space above the muscle the breast can be more perfectly centered over the implant using sub muscular augmentation.  This is effective in mildly ptotic breasts.  Releasing the muscle is standard practice in sub muscular augmentation

William Andrade, MD · Answer

Hello, inserting an implant in a typical submuscular / subpectoral pocket only involves releasing a small amount of muscle to gain access to the space deep to the muscle, plus some muscle fibres are usually released around the borders of the pocket.  In contrast, a dual plane pocket typically involves releasing the pectorals muscle completely along the lower aspect of the breast (inframammary fold).  The goal of making a dual plane pocket is to allow the implant to settle lower within the breast, rather than being held up by the muscle.

Irena Karanetz, MD · Answer

Hello,
Thank you for the question.
Dual-plane breast implant placement implies that the implants are placed under the muscle (hence are sub muscular) but there is also significant amount of pectoralis muscle release that's performed towards to sternum (chest wall bone) in order for the implant to be placed more towards the middle.
In addition, implants can take take 6-12 months to settle fully into the their final position. 
I would encourage you to discuss your questions and concerns with your Plastic Surgeon.
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Ronald J. Edelson, MD · Answer

As far as I’m concerned submuscular and dual plane are the same thing. There is not really any muscle to cover the implant in the lower outer part of the breast so only part of the breast gets covered with muscle anyway

Garrett A. Wirth, MD, MS, FACS · Answer

The dual plane releases some of the Pectoralis Major muscle at the bottom where a total submuscular doesn't release the muscle.  I feel that the total submuscular does tend to hold the implants higher and can lead to breast presentation as you describe.  A full consultation would be necessary to set up a plan for you and I recommend you work with a Board Certified Plastic Surgeon.

Steven A. Hanna, MD, FRCSC · Answer

Thanks for the question. Breast surgery is fraught with poorly defined and antiquated terms, for example "snoopy breast". I actually wrote a paper on this issue with several colleagues (for your reference the paper is titled "The Nomenclature, Terminology and Lexicon of Breast Surgery: Are We Really Saying the Same Thing?"). The term submuscular is one term which can be misleading, and should only be used to describe when the breast implant is in fact entirely under the confluence of chest wall muscles. Using this definition, there is no release of the lower part of the pectoralis muscle.
Dual Plane breast augmentation on the other hand is well defined, and refers to the surgeon dissecting in two areas: beneath/behind the pectoralis major muscle and between the breast gland and the front of the pectoralis muscle. When a surgeon performs a dual plane dissection, they release the lower part of the pectoralis muscle and create a pocket beneath the muscle for the implant. In this case the implant is partially covered by muscle (this is different from a true submuscular dissection). The second plane of dissection that is sometimes included in a dual plane dissection is between the breast gland and the muscle; a surgeon may choose to dissect the gland from the muscle to varying extents in order to achieve more fullness in the lower part of the breast. 
Sorry to hear that your implants may be sitting higher on your chest. I would recommend that you have a formal consult with a board certified Plastic Surgeon with fellowship training in Aesthetic Surgery.

Connie Hiers, MD, FACS · Answer

Typically, the muscle does not fully cover the implants, but covers the upper and inner portion of your breast implant. You may have formed a capsule that has not allowed your implants to drop. That can be fixed.

Submuscular vs. dual plane, which one releases more muscle?

Answers (9)

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