In a dual plane augmentation, what holds the implant up (bottoming out?), and how does it increase the size of the lower pole?

How does a dual plane augmentation of the breast keep the implant from bottoming out? First, practically speaking and with few exceptions, every submuscular breast augmentation is a dual plane procedure because the pectoral muscle only covers the upper 2/3 and medial part of the breast. Below that there is no pectoralis muscle coverage, and any muscle coverage below the pectoralis muscle would have to be the serratus muscle if it were totally submuscular.It sounds like you have a very high inframammory crease and maybe a bit of what is called a Snoopy deformity if the nipple area sags over the IM crease. If that is the case, you may need an uplift (mastopexy). I would rely on your PS to make that determination since eh/she has examined you personally, which is necessary in such cases. If the crease is high, it will have to be lowered, which every PS has done numerous times.There should be no problem with achieving fullness in the lower pole. Controlling any bottoming out would be done by limiting the dissection of the IM crease. Sometimes suturing the crease is necessary to prevent this from occurring. It sounds like your PS is dialed in to the proper method to achieve your desired result.Thank you for your thoughtful question and best of luck.

Great question.The dual plane technique was developed for women who refuse a lift . This technique cuts the muscle to allow the implant to fall directly behind the existing breast mound (low on the chest). Once the muscle is cut, there is nothing to help keep the implant in place. Bottoming out or lateral displacement of the implant is usually the result after a couple of years depending on the size (weight) of the implant. I never cut the muscle as this violates the only supporting structure that helps keep implants in place long term. I hope this helps.Best wishes and kind regards,Gary Horndeski M.D.

A dual plane breast lift means that the upper part of the implant is covered by muscle, but the lower part is released, which allows the implant to expand the overlying breast tissue.  If the muscle is not released (as in a submuscular augmentation), then the breast tissue may not be as fully expanded because the muscle is in between.  Even if the muscle can stretch, the overlying breast tissue is not fully expanded due to the attachments between the breast tissue and muscle. Bottoming out is more likely to occur with any adjustments to the level of the inframammary fold, as well as the weight of the implant.  Some stretching is likely, but the best support is the natural support made by your body.  If muscle is not release to the correct degree (even for a submuscular pocket), one can have a high riding implant with a droopy breast on top.  In your question you don't state if you have droopy empty breast tissue and skin in your lower pole, or you just don't have much in your lower pole, and your skin is not stretched out.  If you don't have much skin, you will likely need less of a dual plane created because your tissue will stretch with the muscle.  However if you have excess skin (saggy breast), then a dual plane is definitely needed to adequately expand that lower pole when you get your implants.Seek an experienced board certified plastic surgeon.