Can you explain the details behind the different levels of Dual Plane method in breast augmentation? (Photo)

Question

I have seen Dual Plane placements listed at different levels (ex. Dual Plane 1 [or 2, or 3, or 4]). From what I gather, the higher the number, the better lift effect it will give (based on patient before and after photos I have seen). Can you please explain the details behind the different levels in the dual plane method?

Shlomo Widder, MD · Answer

Dear kvo,    Thanks for submitting the before and after  pictures . Are you breasts similar and are the after pictures your goal?  The different levels of dual plane breasts augmention that you mention, are not a univesal classification. I , for one , never used it in 27 years of practice. Basically, a dual plane means creation of the implant's pocket partially under the muscle ( upper pocket ) and partially under the skin ( lower pocket ) . At  times , just breast augmentation will give you the result that you presents ( very strechable skin ) and at times a mini lift or even full lift is necrssary. That can be determind only on physical exam by an experience plastic surgeon. I would argue against lowering the inframammary fold as much as was done in your after picture, because the skin is quite thin at that level and the implants will be palpable. A better option will be augmentation with less lowering of the IMF followed by mini lift ( donut ) which will keep the breasts in higher position and with less palpable implants at the lower pole. Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check their before and after pictures to make sure that they are numerous, consistent and attractive. Check also the 'realself' reviews for positive patients experience which provides important information on the surgeons.                     Best of luck,                                       Dr Widder

Larry S. Nichter, MD, MS, FACS · Answer

My best suggestion is to pick the best plastic surgeon rather than the procedure. It is their job to guide you through this process. See below link on how to select the best plastic surgeon for the job.Here is some general information however on the dual plane technique. 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. A grading system has been suggested and published that you are referring to but my impression is that most plastic surgeon's do not refer or use it at this time.

Thomas Trevisani, MD · Answer

Without your photos- it's impossible to assess your case. Generally speaking- implant placement can be completely under the muscle, or completely over the muscle. Often times, it can be partially under the muscle and partially not under the muscle. This is best left to the operating surgeon with the goal in mind to create the most attractive breasts.

Karan Chopra, MD · Answer

Great Question. We use the Dual Plane technique on patients from around the country who are seeking improvement in their nipple position (like a breast lift) without the scars of a breast lift using just the implant. This is achieved by separating the pectoralis muscle from the overlying breast tissue. This allows the breast to move relative to the muscle. When the implant is placed under the muscle this forces the nipple up. it is like if you stand behind a curtain and then walk forward, the bottom of the curtain will lift up off the ground. The difference in the DUAL PLANE 1, 2 and 3 is how much separation is created to increase the amount of lift to fit your unique anatomy.

John J. Edney, MD · Answer

This is a great question.  It shows that you are really doing your homework.When a patient presents with a small amount of breast ptosis (sag) a dual plane breast augmentation is a very effective technique to help avoid the need for a breast lift and still allow the implant to be placed under the muscle.  When an implant is placed under the muscle and the overlying breast has some degree of sag the muscle will hold the implant back and not allow it to fill the loose tissue at the bottom of the breast The word dual means two and the  word plane refers to the natural separation between two layers of tissue.  In the breast there is a natural separation between the breast tissue and the underlying muscle.  During a dual plane augmentation the breast tissue in the lower part of the breast is separated from the underlying muscle.  The muscle is then released along its entire attachment at the bottom of the breast.  The muscle then moves upward like a window shade toward the nipple.  The different levels of the dual plane method refer to the amount and extent of release of the breast tissue from the underlying muscle.  For instance release of the lower one inch of breast tissue from the underlying muscle will give some degree of llift.  If the release extends to or above the nipple a greater amount of lift is achieved.  The level of dual plane augmentation needs to be individualized for each individual patient.  With the restriction of the muscle in the lower part of the breast removed the implant is then allowed to fill the loose sagging part of the lower breast.  This is a very effective technique to help prevent the need for a breast lift in a patient with a small amount of sag and still have a benefits of an implant placed under the muscle.  This technique is also very helpful in the treatment of other conditions with constriction in the lower part of the breast.

Adrian Richards, MBBS, MSc · Answer

Thank you very much for your
interesting question about the different planes of dual plane
augmentation. As you know, the dual plane
technique refers to the implant being placed behind the pectoralis major muscle
but in front of the other muscles of the chest wall including the seriatus
interior muscle which lies lower down your body towards your feet than the
pectoralis muscle.There are a number of different
levels of dual plane augmentation and these relate to the breast tissue itself
is released from the muscle.  The implant
is placed behind the muscle but the breast tissue is attached to the front of
the muscle. Dual plane 1 technique is used
for people with very little breast droop and in my experience is rarely
used. The most common types of dual
plane position are 2 and 3 which means that the muscle is separated from the breast
tissue in front of your implant. The reason this is done is to
allow the breast to fall down to a natural position. Essentially the more ptosis
(natural breast droop) you have in your breast the greater level required to
give a natural result.I hope this has clarified the
issues, I’m sure if you look online you will see illustrations of the different
dual plane positions.Best wishes.

Steven Wallach, MD · Answer

Dural plane refers to using a partial submuscular pocket and freeing the gland at different levels off the pectoralis so that the gland drapes over the implant.

C. Bob Basu, MD, MPH, FACS · Answer

thank you for your question.  a physical exam is really required to give you more advise on what exact type of dual plane technique you would need.  its best to ask your plastic surgeon what he/she recommends as they have had the opportunity to examine you.  best wishes.

R. Stephen Mulholland, MD (retired) · Answer

Dear Kvo5,

Dual plane is a term to describe
the development of a breast implant pocket. 
Breast implant pockets have traditionally been above the muscle, also called
subglandular, or below the muscle, called subpectoral.

However, certain patients benefit
from a breast implant pocket that starts out above the muscle and subglandular
and at a certain distance above the inframammary fold, the dissection pocket is
created under the pectoralis major muscle. 
This dual plane stands for partially subglandular and partially retro or
subpectoral. The various levels – level
one, two, three or four – are used to describe when the transition is made from
the subglandular to the submuscular plane. 
You are quite right that the higher the number, the higher above the
inframammary fold the transition is made; and the more subglandular the
implant, the more projection, lift and rotation effect, in general, the patient
will achieve.  High dual plane patients
generally have a pectoralis or muscle coverage in the upper pole of the breast,
while most of the breast from the nipple-areolar complex below is subglandular.

In the era now of cohesive gel
implants, high dual planes generally don’t suffer the same risks of visible
ripples or textural implant shell abnormalities, as in the saline days, and
high dual plane patients can be very happy.

I trust this is of some assistance
and best of luck.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

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