Dual plane and subfacial - which will age better over time?

Question

Dual plane and subfacial which will age better over time? Im 32 and no kids but will like to hsve kids in ghe future. Whst placement holds better over years? Im quite thin and active - weight lifting I know the pros and cons but still struggling to decide on placement. I will be getting 285 with fat grafting. Does the fat grafting help with me having not much breast tissue ? And can i potentially get subfacial Placement?

Joseph A. Racanelli, DO · Answer

Both dual-plane and subfascial breast augmentation can provide beautiful results, but in a thin patient with limited natural breast tissue, I generally prefer a dual-plane/under-the-muscle approach.
The biggest consideration is coverage. When there is very little breast tissue, placing the implant partially beneath the pectoralis muscle provides an additional layer of coverage over the implant, which can help create a more natural transition and reduce the visibility of implant edges and rippling.
Fat grafting can be useful for refining certain areas and adding a small amount of additional soft-tissue coverage, but it does not replace adequate natural breast tissue. I would not rely on fat grafting alone to compensate for very thin tissue when deciding whether an over-the-muscle or subfascial placement is appropriate.
Being active and weight lifting are certainly part of the discussion because implants beneath the muscle can have some movement with pectoralis contraction. However, that has to be weighed against the benefits of additional implant coverage in a thin patient.
As far as which placement will “age better,” there isn't one plane that guarantees a better result over time. Pregnancy, breastfeeding, weight changes, skin elasticity, genetics, implant size, and your starting anatomy can all affect how your breasts change.
At 285 cc, you are considering a relatively conservative implant size, which may be beneficial. Subfascial placement could potentially be an option, but whether you have enough tissue coverage to make it a good option can only really be determined through an examination. In a thin patient with minimal breast tissue, I would generally lean toward dual-plane placement for the additional coverage it provides.

Geo N. Tabbal, MD · Answer

These are great questions: being thin, lifting, and planning kids later all genuinely matter here.Honestly, neither placement has been shown to age better. Pregnancy and weight changes affect augmented breasts either way, so I wouldn't pick based on that alone.
The real trade-off is coverage versus animation. Dual plane borrows muscle to cover the upper implant, which helps when there's little breast tissue. However, the implant can shift when you contract, something weightlifters notice. Subfascial avoids that, though the fascia is a thin layer, not true padding.
Fat grafting does help you. It adds soft-tissue coverage and softens implant edges, and it's part of why above-muscle placement becomes reasonable for some thin patients. Just know some grafted fat resorbs, and thin patients have less to harvest.
So yes, subfascial could be an option &mdash; but that's an in-person call based on your pinch thickness and available donor fat, not the 285cc plan itself.

Daniel Barrett, MD · Answer

Dear SamShadowx,

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

Brian K. Reedy, MD · Answer

Thanks for your question! They will both age fine depending on your body, tissues, weight fluctuations, etc. I think that you should ask your surgeon what their preference is and why. Without photos, it's very hard to give an educated response. Best of luck!

Semih Yildiz, MD, FEBOPRAS · Answer

In my experience, neither dual-plane nor subfascial placement universally ages better; the choice depends on tissue thickness, skin quality, chest anatomy, implant profile, and future pregnancy plans. In a thin patient with limited breast tissue, dual-plane placement can provide more upper-pole coverage and may reduce visible rippling. Subfascial placement avoids cutting the pectoralis and may reduce animation with muscle activity, but its coverage is still limited compared with muscle. Fat grafting can improve camouflage and contour, but it is not a substitute for soft-tissue coverage and some fat may not persist. Pregnancy and weight changes can alter the breast envelope regardless of plane. Ask your surgeon to measure pinch thickness, assess muscle movement, and explain your individual risks of rippling, animation, malposition, and revision.

Emre Guvercin, MD, FEBOPRAS · Answer

When thinking about how the breast will age over time, I believe preservation of the breast’s natural fascial and ligamentous anatomy is more important than simply choosing between dual-plane and conventional subfascial placement. This is why I prefer tissue-preservation techniques such as Preservé and Mia Femtech in suitable patients. By minimizing disruption of the breast’s supporting structures and avoiding pectoralis muscle disruption, these techniques aim to maintain the native support system of the breast, which may help provide better long-term stability. For someone who is thin, active, and weight trains, avoiding muscle manipulation also eliminates the concern of animation deformity. Fat grafting can provide additional coverage when breast tissue is thin, although it does not replace the structural support of the fascia. Pregnancy will still change the breast regardless of technique, so no approach can completely prevent future sagging.

Donovan Rosas, MD · Answer

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 
when compared to subpectoral augmentation.

•	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.

Subpectoral Augmentation (“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.

With regards to aging, they will also age differently. Aging has a negative impact regardless of plane of augmentation and will inevitably require revision. Subglandular implants will descend with the native breast ("rock in a sock"). Dual plane/submuscular implants will not descend with the native breast creating a dual mound effect. Either can be corrected with a mastopexy.

Each approach has both costs and benefits. Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other.  As always, your board certified plastic surgeon can help guide you in your decision making process.

Patrick Tansley, MSc, MD, FRCS(Plast) · Answer

Dear SamShadowx, Thank you for your question. I consider that a simplistic answer to a complex question of whether to have implants placed 'dual plane vs subfacial' would be unhelpful to you. There are numerous variables involved in assessing and advising about plane of augmentation. You have mentioned but a few and also included fat grafting which further complicates the picture. In short, you need good professional advice to help you select the most appropriate option(s) for you. I suggest consulting a specialist plastic surgeon trained and experienced in aesthetic breast surgery who can assist you. Best of luck. Kind regards, Patrick Tansley, Specialist Plastic Surgeon. (Australian registration: MED 0001651716, Registered medical practitioner, Specialist Plastic Surgeon (Specialist Registration Surgery – Plastic Surgery); United Kingdom registration: 4153720, GMC Specialist Register (Plastic & Reconstructive Surgery).

Zoran Potparic, MD · Answer

It is impossible to make this comparison in terms of longevity, unfortunately; long term result mostly depends of patient own skin, breast tissue elasticity and support. I am not aware of any study which could give us long term comparison, prognosis. I hope it helps.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I have performed over 7700 patients with dual plane breast augmentations over thirty years and they have held up well. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Dual plane and subfacial - which will age better over time?

Answers (12)

More Breast Augmentation Questions

Does animation deformity go away?

Will 400cc implants give more upper pole fullness or do I need a lift? (Photos)

Asymmetry in breasts after breast augmentation - can this be fixed? (Photos)

How Does Pectus Excavatum Impact a Lift/Implants? (Photo)

What is the Recommended Recovery Time for Flight Attendants after Breast Augmentation?

Dual plane or over the muscle? (Photos)

WE SEND PRETTY
EMAILS