Is there any long term negative effect of a dual plane breast augmentation vs. regular submuscular?

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach.
 Subglandular Augmentation (“overs”): 
Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster.Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling when compared to subpectoral augmentation.Subglandular implants can also create the illusion of improved cleavage by preferential over-dissection of the central/medial pocket allowing the implants to be forced more to the midline. There is no limiting muscle as there is in a submuscular augmentation. 
Subpectoral Augmentation/Sub-muscular/Dual Plane (“unders”): 
Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.Subpectoral implants have a lower rate of capsular contracture.Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.In my practice, the vast majority of patients will have the implants placed submuscular for all the reasons listed above. This is also known as a dual plane (due to the fact following muscle release half the implant is under the muscle while the lower pole is not). Complete submuscular coverage is rarely performed due to the distorting pull of the muscle.
With regards to your specific question, subglandular is preferred when animation is a major concern. However, animation is a less noticeable phenomenon in cosmetic augmentation (vs. reconstruction).
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Dear xStar,
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

Hello there Almost all submuscular pockets ARE in fact , dual plane . Total submuscular coverage is rare ; you might see it with breast reconstruction after mastectomy .I don't think you need to worry about long-term adverse effects from dual plane placement . All techniques have pros and cons , but dual plane is very 'tried and tested' .Subfascial placement can work well for some patients but it depends on your breast and soft tissues , plus the size and nature of your implant .CheersTS

Dual plane breast augmentation refers to the amount of interface the implant has with the pectoralis muscle and the breast tissue.  Dual Plane I is how many surgeons perform routine breast augmentation where the muscle is release 1cm or so up from its insertion on the chest wall but not from the sternum.  This allows the implant to be in contact mostly with the muscle and interface with the breast tissue only in the lower part of the breast.  Dual Plane II and III involve letting the muscle slide up to the level of the nipple and above the nipple respectively.  This allows for increasingly more implant-breast tissue interface in both types.  
Good results are possible with all three techniques, and like all surgical choices, there are pros and cons to each.  I recommend discussing the choices with your surgeon to hear what he or she thinks is best for you.  

Thank you for the question. Semantics can be confusing.  When surgeons talk about placing breast implants "behind the muscle", they are usually referring to  "partial" or "dual plane"  positioning. In other words, all of these terms refer to the same sub muscular (as opposed to sub glandular positioning) positioning of breast implants.  Complete submuscular placement of breast implants would be very unusual.


Dual plane breast augmentation refers to the technique where breast implants are placed under the muscle superiorly and in the sub glandular  position inferiorly.  I think this is the best way to go for most patients. On the one hand, patients benefit from the sub muscular position with increased tissue coverage of the breast implant, less chance of encapsulation, less potential for rippling/palpability of the implants and less interference with mammography.
On the other hand, because the implants are not completely sub muscular there is the potential for less “distortion” of the breast implants with pectoralis movement. Generally, in my opinion, the breasts also look better with breast implants in this position.
I hope this helps.