What is the Dual Plane Method for Breast Augmentation or Breast Implants?

Most patients and even surgeons don't really know what is meant by " dual plane ". The simple way to think of it is yes, that implant is under the pectoral muscle up top and below the breast tissue on the bottom. Otherwise known as partially under the muscle.  What is actually meant by " dual plane " is that in addition to making the pocket in this location dissection is also performed above the muscle. This plane of dissection is taken up for several centimers and it's purpose is to loosen the muscle from the overlying breast tissue. This technique is supposed to be useful for patients who have slightly droopy breasts where the muscle would restrict the expansion of the overlying droopy breast tissue in an adequate fashion. There are other methods of loosening this breast tissue besides the dual plane technique, but really it is only useful for this specific subset of patients. Most patients don't even need it.

Bottom line is you need to go to someone that does good work. Look at photos ask for a referral from a friend.  Asking a surgeon whether or not they do " dual plane " is silly and a waste of time in my opinion. Because really most surgeons haven't read the article so they don't know what it really means. They just assume, as I used to, that it means under the pectoralis muscle.

The question to ask is do you go under the muscle or over the muscle, meaning the pectoralis muscle only.  I don't know anyone that does " completely under " the muscle which involves lifting other small muscles.

Thank you for your question. The below is a description of the dual-plane implant placement from my website. Take a look at my Guide to Breast Augmentation from the web reference below, which answers this and other questions about breast augmentation (saline vs silicone implants, round vs anatomical implants, smooth vs textured, implant profile selection, implant insertion incision placement, implant manufacturer, etc).Dr. Zuckerman would make the pocket under the pectoralis major muscle, similar to a submuscular placement, and then free up the interface between breast gland and the muscle so that the breast implant slides. In this placement, the breast implant contacts the bottom part of the breast gland, which hinges the breast mound & tissue to give a little bit more of a lift out of the augmentation. There are three variations of this technique depending on how much of the interface vertically is freed up, and which variation to choose depends on how much lift you would like to achieve. However, this placement cannot be used in place of a mastopexy.

Understanding dual plane means you have to understand some basic concepts about the muscle anatomy of the chest wall.The chest wall muscle important in breast augmentation is called the
pectoralis major muscle….otherwise known as the pec muscle. This muscle extends
from the arm bone, called the humerus, near the shoulder, and attaches to the
chest wall near the midline.
How the implant is placed in relation
to this muscle is important in determining the final long term result.
The implant can be placed in front of
the muscle.
However, most surgeons choose to place
the implants under the muscle which is often referred to as a subpectoral
placement or “unders”.

However, an implant placed under the muscle is never completely covered
by muscle, with the lower part of the implant extending below the lower border
of the muscle.
Dual plane refers to implants that are partially covered by muscle and partially
covered by breast tissue. Therefore, effectively ALL under the muscle implants
are "dual plane".

A standard subpectoral implant pocket is often referred to as a dual
plane type 1 placement.
The placement of the implant in a dual plane type 1 follows several steps:The lower end of the pec muscle is identified
and then detached from the chest wall at the lower end to make room for the
implant. However, as the muscle remains attached to the overlying breast tissue
it doesn’t retract, or move too far.A space, or pocket, is then created under the
pec muscle large enough to accommodate the chosen implant.Once the pocket is created, the implant is then
inserted and positioned.In this situation the outer/lower aspect of the
implant is not covered by muscle - "dual plane".However,
as the muscle remains attached to the breast tissue and close to the lower
curve of the breast, then as this muscle contracts it often pulls the skin in
causing a groove along the lower breast curve. This is referred to as a dynamic
double bubble and is quite common.

Another form of under the muscle implant placement is the dual plane
type 2.
In this situation, many of the
surgical steps are the same as the dual plane type 1. The lower end of the pec muscle is identified. However, unlike the dual plane type 1, the
breast tissue is detached from the pec muscle approximately up to the level of
the nipple.The space under the muscle is then opened and
the lower end of the pec muscle is detached from the chest wall.With the muscle now detached from the both chest
wall and the breast tissue, this segment of the pec muscle retracts upwards.With the under muscle pocket created, the
implant is inserted and positioned and the wound is closed.
The dual plane type 2 implant placement results in less of the implant
covered by muscle along the lower half of the implant ….and this can have the
benefit of a fuller more curvaceous underboob.
It also significantly reduces the
potential for a dynamic double bubble as this muscle is no longer close to the
skin along the lower curve of the breast.
One of the negative issues of a dual
plane type 2 approach is that the detached segment of pec muscle is no longer
functional…. so you can expect a slight reduction in pec muscle strength.
However for the majority of people this is not noticeable. Pros and cons exist for each technique so speak to your plastic surgeon to find out what will give you the best outcome.

Dual plane breast augmentation is one of the many options
available for patients undergoing breast augmentation surgery.This procedure offers significant benefits
for patients with specific anatomic findings and aesthetic goals. It’s
not unusual for plastic surgeons to encounter patients who have breast
hypoplasia associated with mild breast sag.These patients want larger breasts but don’t want the scarring that’s
frequently seen with breast lift surgery. Under
these circumstances, dual plane breast augmentation offers significant
advantages.This procedure creates a
pocket beneath the pectoralis muscle as well as a separation between the muscle
and the overlying breast tissue.This
results in the implant having muscle coverage superiorly and breast tissue
covering the implant inferiorly. This
configuration allows the breast tissue to cover the implants in a more natural
way.It avoids the need for a breast
lift and avoids a snoop dog or double bubble deformity.In addition, the patient continues to have
the advantages of submuscular implant placement including a decreased risk of
capsular contracture. If
you’re considering breast augmentation and have mild breast sag, you may be an
excellent candidate for this procedure.Under these circumstances, it’s important to consult a board certified
plastic surgeon.

For cosmetic Breast Augmentation, the dual plane technique refers to the implant being partially beneath the pectoralis muscle. As the lower part of this muscle is above the lower lateral part of the breast most Subpectoral implants are in fact to a degree dual plane although erroneously often called total submuscular. However, the degree of the implant is beneath the muscle on top and soft breast tissue below can be altered by making the submuscular pocket higher up the muscle leaving some of it below the implant below and some above. The advantage of this is to expand the lower pole of the breast if short or more often for mild drooping breast correction.

Dual plane breast augmentation simply means that the implant is placed partially under the muscle. Just the top portion of the implant is put under the chest muscle, while the rest of the implant is only under the glandular tissue. True sub muscular placement involves the implant being placed entirely under the muscle, and this is usually only done for breast reconstruction patients because of its related risks.Dual plane is very common because it provides greater coverage. It is also better supported, slowing the rate of sagging.

As Dr. Kim has quite rightly pointed out, that the Dual plane technique involves creating a generous pocket under the pectoralis major muscle while, curiously, separating the upper surface of the pectoralis major muscle from the overlying breast tissue for a few inches. What one ends up with is a loose pectoralis major muscle that covers the superior aspect of the implant similar to an "apron". In this way, the pectoralis major muscle, during the postoperative period of healing, is allowed to find and heal  in its own natural resting position relative to the overlying breast tissue.

This technique provides a number of advantages over traditional "under the muscle"/sub pectoral techniques alone.

The first is that this technique allows minimization of flexion/contraction deformity when patients flex their pec muscles while their implants are in the "under the muscle" position.



A second advantage of the "dual plane" technique is realized when a patient has a constricted breast deformity whereby the distance from the lower edge of the areola to the lower breast crease is under 4 cm and their nipple is pointing downwards as a result. This could be part of a tubular breast deformity as well. By performing a dual plane technique in these cases, one can benefit from both the sub pectoral/ "under the muscle" position while having the lower pole of the breast expand maximally to accommodate the breast implant itself. In this way, the implant can sit in its proper position relative to the overlying breast, imparting the most natural result possible in these otherwise difficult cases.



The third advantage was pointed out by one of the other doctors in answering this question. The dual plane technique is appropriate for those breasts that are elongated and "droopy" after children and breast feeding. By fully releasing the muscle and allowing it to act as an apron, the implant can sit in its proper position behind the bulk of the breast  (in the standing position) thereby avoiding a high-riding breast implant in which the breast tissue seems to just hang like a "double chin" off the implant itself. However, though the dual plane technique provides a very natural result in these cases, the patient may feel that they are now more droopy and have a "rock-in-a-sock" appearance to their breasts. A breast lift or mastopexy should be performed at the same time if the patient is amenable to the extra scarring.

Let me clarify some terminology that many plastic surgeons themselves misuse.


Submuscular = the implant is COMPLETELY under the muscle with no release of the muscle (rarely done).

Subpectoral = the implant is placed under the pectoralis major muscle, with the inferior edge of the muscle released so that the lower portion of the implant is covered by gland.  This is what most people refer to as "submuscular"; however, they are technically incorrect. A classical subpectoral placement is the same as a Dual Plane I.

Dual Plane = a form of subpectoral implantation with varying degrees of muscle release/separation from the gland in order to vary the amount of muscle/gland coverage ratio.


It may be semantics, but semantics are important.  In summary, Dual Plane is a form of under the muscle or subpectoral placement.

The term “dual plane” is used to describe an operation when the implant is placed beneath the pectoralis major muscle superiorly but lies directly under the breast tissue inferiorly. This technique requires dissection in both planes and is best for thin patients with moderate amounts of ptosis (i.e. drooping of the breasts) that would be difficult to correct with subpectoral or subglandular implant placement alone.

Hi there,

In the vast majority of practices, the terms submuscular and dual plane are interchangeable. As my colleagues below have said, this means the top of the implant is under your chest muscle, and the bottom under breast tissue.

The real variability is what (if anything) is done to your muscle to create the best shape for you. Be careful not to allow yourself to believe that as long as the right words are used you are getting the same procedure in different offices. 

 

The Dual Plane breast augmentation involves having the implant partly covered by muscle on the top half of the implant and under the breast tissue at the bottom half of the implant.  For this technique, the muscle has to be divided carefully to prevent the implant settling into the wrong plane. If you have not already done so, see two or more board-certified plastic surgeons in your area who are experienced in breast augmentation for a full evaluation to make sure you are a good candidate for breast augmenation and that it is safe for you to have surgery.  I hope this helps.