This is a very excellent question, and I'm glad you asked it. It will take a bit of mental imagery on your part to understand what's going on, because it all has to do with the anatomy of the breast and chest. In short, what a "dual plane" augmentation means is that we have lifted the breast tissue on the bottom of the breast, between the level of the nipple to the level of the inframammary fold below the breast, off of its connections to the underlying muscle. Are you with me so far? The breast is normally connected to the underlying muscle, and if we simply go in and lift breast and muscle as a unit, without first disconnecting the lower breast tissue attachments to the muscle, we are doing essentially a classic submuscular pocket. Lifting the lower breast tissue first away from the muscle and then lifting the bottom of the muscle from the rib cage makes this a dual plane. The important thing to recognize is that the lower breast tissue is now free to drape and wrap around the implant, while the upper breast remains attached to the muscle and the implant goes under all of that on top. This creates a better fill of that lower breast tissue and a more natural look in most cases. It prevents that lower breast tissue from remaining attached to the muscle and behaving independently of the implant, causing things like "Snoopy breast" with the loose breast tissue hanging off of the bottom of the implant. Thus, the thing that prevents bottoming out is the surgeon keeping that entire pocket dissection above the level of the inframammary fold and the tough attachments of that fold to the underlying chest wall. This is the lower border of the breast, and it is when this is violated that implants can slide down behind it along the chest wall and cause "bottoming out." As long as this fold is respected and left intact, the implants won't bottom out. The dual plane, done properly, in my opinion is the technique MOST likely to produce a fuller lower pole, as it creates the most tension, and thus expansion, of the lower pole tissues between the (remember, intact) inframammary fold and the nipple. That is what creates that nice, full lower breast contour. That happens with a properly done dual plane. I do at least some degree of dual plane on just about 100% of my breast augmentations, regardless of age or other factors, simply because I think it creates the most natural results, and I have about a 0% incidence of bottoming out. I also don't have a problem with implants falling out to the side under the arms either, and I would venture to say that the dual plane is probably more likely to prevent any implant displacement problems at all, bottoming out included. This is because the exposure of anatomical landmarks like the lower and lateral edge of the pectoralis muscle is so much better that the surgeon has better control and accuracy of these critical endpoints of pocket dissection, so he is less likely to over-dissect the pocket in those locations and have displacement or malposition issues later. In some instances we might have to adjust that inframammary fold placement if it's too high, or if the lower pole tissues are constricted, such as in cases of tuberous breast or constricted breast deformities. I wonder if you don't have something like that going on, based upon your description of an "almost non-existent" lower pole and possibly needing a lift. Some girls with tuberous breast require a lift to control areolar herniation. Even still, I would do a dual plane dissection in cases like that, relaxing incisions in the breast tissue internally if need be, and a reattachment of deep tissues to the chest wall lower down to re-create a fold and prevent bottoming out, if need be. But I would still do the dual plane dissection, regardless, as that will still help expand the lower breast tissues better.Thanks for your excellent question, and it sounds like your surgeon has things "under control." As long as he relates to you his understanding of the importance of the inframammary fold, I would say he knows exactly what he's doing with regard to the fuller lower pole, and you should trust his instincts with the dual plane approach. Best of luck.