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

The connective tissue along the inframammary fold holds the implant up no matter what technique is used. I don't completely understand from your description why you were told that you may need a lift. If you have a non-existent lower pole, I'm assuming that you don't have any sagging. If your nipple to fold distance is short and you have a well defined inframammary fold, I prefer to leave the fold at its current location and elevate the nipple. I find that trying to lower tight folds causes a double bubble most of the time. I understand that many doctors score and stretch the fold, but I frequently see patients for revision surgery that have a lower pole crease caused by trying to lower the fold.

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.

Thank you for your excellent questions and for doing your research.  Dual plane augmentation is the standard procedure for most plastic surgeons in the US, with muscle covering the upper portion of the implant and the lower portion of the implant covered by your breast gland.  There is a network of supporting tissue along the breast crease termed the inframammary fold that helps reduce the risk of bottoming out and is protected during the surgical dissection.  The lower portion of the breast enlarges due to the redistribution of the implant volume once the implant "drops."  This places pressure on the lower pole causing the skin to stretch.  Hope this helps.

Dual plane breast augmentation is a powerful way to improve your aesthetic results.  It is used to describe the procedure and should not be confused with some fancy procedure.  Most of the breast implants placed under the muscle is placed in the dual plant.  It is just the degree of release that the surgeon controls to maximize control of the breast pocket.  Dual plane does not cause or prevent bottoming out.  I am sure your surgeon is quite aware of this and you will have a great result.In my practice, bottoming out is not a common complication.Best Wishes,Nana Mizuguchi, MD