Dual Plane Differences? (photos)

The technical concerns you are discussing are differences that the surgeon would be considering to treat your particular anatomy.  It is really not something that you would be involved in deciding.  The technique is the same for 1, 2, and 3.  This is just an article that is finely differentiating what is happening when you are operating on a specific breast type.  The surgeon does not start a case and say, "I'm going to perform DP2".  The most sophisticated approach to
breast augmentation is through the armpit with a surgical camera (transaxillary
endoscopic). Using this modern approach the space can be crafted under direct
vision, with virtually no bleeding and no postoperative bruising. Most
importantly, the shape of the breast is meticulously created. The other, older
methods of insertion are technologically less advanced. Both silicone and
saline implants can be placed through the armpit by a surgeon with skill and
experience using this approach. The incision in the crease is the oldest method
of placing the implants and puts a scar directly on the breast.



A round implant would be a better
choice because they move more like breasts. The anatomic implants have a
textured surface which makes them feel very unnatural. In addition, there is no
benefit to anatomical. There is an X-Ray study that shows the implants from the
side at 6 months. Standing, the round and the antomical implants have the same
profile. When you lie down however, the anatomical implants do not change,
which is unnatural. A round implant will change when you lie down, like a natural
breast would.



HP implants, which are a more modern
shape than moderate profile implants, fit most women better. They have a more
appropriate base diameter and can be made to look very natural or very
augmented, depending on where in the range the implants are filled to achieve a
particular volume. High profile implants are the first choice in my opinion. I
rarely find an indication to use moderate or moderate plus implants. The
subtlety in the final outcome is not achieved by which profile implant is used,
it is determined by the skill in the creation of the pocket, the choice of
volume, and where in the range the implant is filled.



There
are many advantages to sub muscular dual plane placement and very many
disadvantages to sub glandular placement. I would see no indication to do
anything but sub muscular dual plane. Subglandular silicone implant
placement is the historical approach to this surgery, and was widely used in
the 1960's. The implant edges are more visible, the risk of rippling is
higher, the implant is in contact with the non-sterile breast tissue so the
risk of infection and capsular contracture is higher. The interface
between the breast tissue and the muscle is blurred so the implant interferes
with mammography more than sub muscular placement. The blood supply
surrounding the implant is worse so the risk of capsular contracture is higher.
The support for the implant is less so there is more long term shape
abnormalities and sagging. The look of a sub glandular implant is much
less appealing than a sub muscular implant. The placement of sub
glandular implants makes any subsequent revision surgeries more complicated and
less successful. There are no advantages to sub glandular implant
placement.



The choice between saline and silicone
is one that requires a complex discussion of all of the advantages and
disadvantages of both implants. The issues to be considered are safety,
density, mobility, rippling, rupture rate, consequences of rupture, detection
of rupture, need for follow-up care, cost of follow-up, appearance, feel,
sensation of heaviness, radio-density, mammograms, and costs, among other
things. There are advantages and disadvantages of both products. The decision
will ultimately be up to you based on what is appropriate for your particular
situation. Beautiful results can be obtained with either implant.



The best way to determine the size that
fits your personal perception of the perfect breast is to try on sizers. This
way you can see how they fit on you, how they add to your current volume, and
whether they fit your frame. Although the surgeon can guide you, only you will
be able to tell what is the right size. Try on sizers. Measuring a diameter and
then telling the patient what volume they can have (in high, moderate or
moderate plus implants) in my mind is backwards. The patients should be allowed
to choose the volume. Then the surgeon carefully considers the base diameter,
projection, profile, manufacturer, and fill material that will achieve the
patients goals of size as well as qualitative look (natural, intermediate, or
bold upper pole fullness or projection), all the while taking into consideration
the patient's anatomic features that will affect the outcome. The experience of
the surgeon and the degree to which they explain the options to you is of
utmost importance. The subtlety in the final outcome is not achieved by which
profile implant is used, it is determined by the skill in the creation of the
pocket, the choice of implant. Don't let the doctor tell you what would look
good on you. They cannot tell what you perceive to be the best size. There is
no maximum. That is up to you.

Dual plane refers to positioning an implant in a sub muscular pocket and how much release of the gland from the muscle is performed.  The actual numbers really are theoretical amount of release from the gland.  In my opinion, just by releasing the muscle from its insertion along the inferomedial aspect will case the muscle to only cover the upper 1/3-1/2 implant.(2,3)