Dual plane breast augmentation versus subfascial placement?

Thank you for your questions. Although there are several nuances to this question, I am going to try to boil down the basics to hopefully make things easier to understand. First, for the sake of discussion, lets just say that while "dual plane" is a technical term, it is essentially the same as a submuscular augmentation, so those terms are interchangeable. The term "subfascial" is a fancy sounding word that in my opinion is just a way to "rebrand" a subglandular augmentation. So we are really talking about two options here, submuscular or subglandular. So let me try to break it down for you:Subglandular:(+): shorter procedure, less pain/recovery, no animation deformity(-): higher risk of implant visibility, palpability, rippling, capsular contractureSubmuscular:(+): Less capsular contracture risk, less implant visibility, better upper pole transition in small/thin patients(-): More discomfort/recovery, animation deformityThis is obviously an oversimplified list, but what you need to decide is which is most important to you and go over that with your surgeon. For most of my patients, the short term benefits of subglandular implants do not outweigh the long term benefits of submuscular placement. Make sure you are seeing a plastic surgeon who is board certified by the American Board of Plastic Surgery who is spending enough time with you to go over all these things and come up with a customized approach for you that meets your goals rather than plugging you into some formula they use for everyone. Hope this helps!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

Than you for your question because it's a good one. Many surgeons use the term 'dual plane' in the wrong way. It was originally described by Dr. Tebbetts to include certain steps, that many surgeons do routinely----the finer points of the surgery could be discussed by your surgeon-----but the important thing is to realize that it is essentially a 'submuscular' augmentation, which most of us do routinely because it gives the best contours especially in the thin, athletic woman. There are many unacceptable tradeoffs if you put the implant 'above' the muscle to avoid all animation. My patients tend to be athletes, aerobic instructors, etc so I have experience with this and you should seek a surgeon with many years of experience. Hope this helps.Leland Deane MD FACSCastle Connolly Best Doctor

These approaches address 2 unique problems in breast augmentation: breast ptosis and animation deformity. Subfascial eliminates animation deformity while dual plane does not. Dual plane is used to augment mildly ptotic breasts but maintaining the benefits of a submuscular augmentation.

Dear Nicole6345,
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 thank you for your question and provided inforamtion as well;..based in your question its difficulted evaulate your case if the question dont have a picture, its recommended to get a consultation in personal with a plastic surgeon.

Thank you for sharing your excellent question. Due to your small frame and limited chest tissue it would be best to increase coverage of the implant with placement beneath the muscle.  This also trends towards fewer complications.  Hope this helps.

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  The answer will depend on your specific breast anatomy.  Generally speaking, I usually prefer a dual plane technique, as this has less risk of capsular contracture and less risk of rippling.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.   Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.  

Best wishes and good luck.


Richard G. Reish, M.D.  FACS

Harvard-trained plastic surgeon
 

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. 
With regards to your specific question, dual plane is equivalent to submuscular (as it is highly uncommon to leave the muscle intact when placing the implants- this would lead to the high and tight appearance you described. Subfascial augmentation is a variation on submuscular in which the muscle is left intact and the thin connective tissue overlying the muscle is raised instead. This does avoid the animation deformity associated with submuscular placement, however this provides little to no camouflage for the implant (which is the entire point of submuscular placement).Additionally, the fascia must remain in contact with some tissue. In the setting of a previous subglandular augmentation, this thin tissue would be very tenuous basically floating between the prior and current augmentation planes. If this is the chosen approach, you might be better served to stage the procedures.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

IN my opinion, for small breasted women such as you, and particularly with dense breasts, a dual plane procedure would be preferred, to hid the upper edge of the implant, make capsular contractures less likely, and make your breast mammography studies easier to do in the future.  This is an opinion, and not a medical recommendation, since you are not a patient that I have had a chance to examine.In good hands, and for the right candidates, the results can be phenomenal, so be sure to select a board-certified experienced plastic surgeon to evaluate and treat you.

Thank you so much for your question. 

This is an interesting topic. There are plusses and minuses to every devision in medicine. In essence:

Sub glandular:
(+) no animation deformity, theoretically better projection, theoretic better cleavage creation
(-): higher risk of implant visibility, palpability, rippling, capsular contracture
Dual Plane:
(+): Less capsular contracture risk, less implant visibility, better upper pole transition in small/thin patients
(-):  animation deformity

To be frank. I almost exclusively do dual plane in my practice due to the higher risk. Animation deformity is not usually problematic in most patients. 

I hope this answers your questions