The dual plane technique is a form of subpectoral - or ‘under the muscle’ - breast implant placement. There are two main kinds of implant placement:
- Above the muscle, whereby the implant is completely above the muscle
- Under the muscle, whereby the implant is placed under the pectorals muscle, in varying degrees
During a dual plane augmentation, the implant is placed under the pectoral muscle at the upper, and sometimes mid, part of the breast, but the lower part of the implant is not covered by the muscle. The varying different degrees of muscle coverage over the implant depends on the patient’s current breast shape and desired result, and that’s why it’s important to choose a surgeon that is experienced in this technique, as the ratio of muscle-covered implant to uncovered implant makes subtle adjustments that impact your result.
The dual plane technique is a form of under-muscle augmentation, but that is not its only defining attribute. The ‘dual’ in ‘dual plane’ actually refers to the fact that the surgeon dissects (or cuts) a pocket out for the breast implant under the muscle, but also dissects off a portion of the breast tissue that’s connected to the muscle. So a dual plane augmentation involves dissection under the muscle, and above the muscle.
Below: breast augmentation results using the dual plane method, performed by Dr David Sharp
What happens during a dual plane augmentation?
The surgery itself is very similar to a classic breast augmentation. Your surgeon will dissect a ‘pocket’ under the pectoral muscle, lifting the muscle off the chest wall and making space for the implant. Where it veers from a traditional augmentation is that the surgeon will also detach a portion of where the breast tissue connects to the top of the muscle, leaving a dissection on two planes: above the muscle, and below the muscle.
The purpose of this dual dissection is to detach part of the muscle from the overlying breast tissue, so the breast implant and muscles can relax into a natural shape without holding it to the position of the upper breast tissue, areola/nipple and skin.
The implant is positioned and any adjustments made before suturing the breasts closed.
During the post operative healing period, the pectoral muscle and implant is allowed to find their own natural resting position, relative to the overlying breast tissue. That’s why the final result of dual plane breast augmentations can take some time to reveal themselves, as these tissues go through various healing stages during the post operative period until they settle into place.
Is the dual plane technique right for me?
This technique was developed for women with low grade breast droop, or ptosis - as well as those desiring a more natural, lower fullness in their final result. In a classic breast augmentation, the pectoral muscle would restrict the adequate expansion of the overlying sagging breast tissue. This is seen most commonly in women who have lost weight, breastfed or found that ageing lead to excess lower breast (called ‘lower pole’) skin.
Patients who have constricted breast deformity, or tuberous breasts - where the distance from the lower edge of the areola to the lower breast crease is smaller (and often, the nipple is pointing downwards) - can also benefit from this technique. They find that as the lower pole of the breast expands to accommodate the breast implant itself, the implant sits in a more natural position relative to the overlying breast tissue. This can benefit women with tuberous breast deformity as well.
By strategically releasing the muscle, and allowing it to act as an apron the implant can sit in a more natural position, avoiding the ‘bolt on’, overly high appearance of breast implants, and reducing the chance of having excess breast tissue ‘falling off’ off lower portion of the implant (or a ‘snoopy’ nose appearance).
After assessing your breasts and discussing your desired result, your surgeon will explain whether the dual plane technique is right for you.
Does the dual plane method replace the need for a breast lift (mastopexy)?
Not if you have true breast ptosis. The dual plane technique can be adjusted to fill out the lower breast pole in women who might have ‘borderline’ ptosis, or psudeotosis - whereby their nipples don’t actually sit below their inframammary fold - where there is breast droop and skin laxity that creates the appearance of a ‘sagging’ breast. For women with actual ptosis, the dual plane technique will not replace the need for a breast lift. While a well-chosen and strategically placed implant will give the breast a lifted appearance and raise the position of the areola/nipple on the breast, in cases of clinical ptosis, a breast lift with your augmentation will achieve the best long term results.
In a dual plane augmentation, what is holding the implant up?
The network of supporting tissue along the inframammary fold helps reduce the risk of bottoming out. Once the implant ‘drops’ into place, the lower pole of the breast will enlarge due to implant volume, placing pressure on the lower pole and causing the skin to stretch. The surgeon keeps their pocket dissection above the inframammary fold, and does not cut through the strong attachments of that fold to the underlying chest wall. The dual plane technique exposures the anatomical landmarks like the lower and lateral edge of the pectoral muscle, so the surgeon has better control of the critical boundaries of the pocket dissection. In some cases, women require adjustment of the inframammary fold placement if it is too high, or if when the lower pole tissues are constricted (for example, tuberous breast deformity).
Are there different types of dual plane augmentation?
Depending on which surgeon you speak to, there can be 2 or 3 different types of dual plane placements. A standard subpectoral implant pocket is often referred to as a dual plane type 1 placement.
A type 2 is for very mild ptosis, and type 3 is for mild to moderate (or ‘borderline’) ptosis. Dr Sharp uses some variation of the dual plane method in most cases to create a more natural result.
Type 1 dual plane technique
In a type 1 placement, the lower end of the pectoral muscle is detached from the chest wall to make space for the implant. The muscle remains attached to the overlying breast tissue and is not raised up very far. The pocket is then created under the muscle to accommodate the implant. In a type 1 placement, only the lower part of the implant is not covered by muscle. Because the muscle is left attached to the breast tissue above it, women may find that when they contract their pectoral muscle, it pulls the skin around the lower portion of the implant, in causing a groove along the breast curve, which is very common, and referred to as a flexion/contraction deformity or ‘dynamic’ double bubble because you only see it when contracting this muscle.
Type 2 and 3 dual plane technique
Unlike the dual plane type 1, the breast tissue is detached (or dissected) away from the pectoral muscle, up to around the same level as where the nipple sits, depending on the degree of breast droop. The pocket under the muscle is created, and the lower end of the muscle detached from the chest wall, allowing it to move, or retract, upwards. The implant is placed in position, and the breast closed. As a result, the lower half of the implant is only covered by breast tissue, reducing the possibility of dynamic double bubble and creating a more filled-out appearance in the lower half of the breast.
Will I still be able to exercise after a dual plane breast augmentation?
In the case of dual plane types 2 or 3, patients can find that the detached segment of pectoral muscle is weakened, so some reduction in pectoral muscle strength may be expected. However most of our patients find that after they begin to gradually ease into normal workouts/physical activity 6 weeks post operatively, the reduced muscle strength is not noticeable.
What are the risks of the dual plane technique?
The main risks and complications are the same as any breast augmentation surgery. Specific to dual plane augmentation, if the muscle is not released to the correct degree (even for a submuscular pocket), it can result in a high-riding implant with a droopy breast, or ‘snoopy nose’.
There are benefits and negatives to each breast augmentation technique. Speak to your plastic surgeon to find out what will give you the best result.