Dual plane breast augment, a personal perspective.

If you’ve been diligently doing your research, and you understand the differences between subpectoral breast implants and subglandular breast implants, you’re ready to take it to the next level. Dual plane breast augmentation.

Dual plane is a surgical technique combining elements of both the subglandular technique and the subpectoral technique. It was ‘invented’ or at least given a special name, in the early 2000’s. To a certain extent, like many ‘plastic surgery innovations’, it was and is more a marketing gimmick than a game changing technique. I’m OK to say that, ‘cos I do a lot of them!

Plastic surgery patients love the idea that they are getting something special, or different, or better, or exclusive. Marketing managers know that patients love that. Marketing managers tell plastic surgeons that they need to offer something special etc and abracadabra, a ‘New Advanced Imaginary Latest Extremely Difficult Innovative Technique’ is born. ie subfascial pocket, muscle splitting pocket etc etc.

The truth is, that I can recall seeing surgeons in the 1990’s performing what they were naming “subpectoral breast augmentation” and doing everything during the surgery that these days in 2017 would be called a “dual plane augmentation”. The actual intraoperative technical details of ‘dual plane’ are useful and valuable. The special name given to it, not so much.

What is dual plane breast enlargement?

In a standard ‘subpectoral’ pocket technique, the implant is positioned so the top part of it is covered by the pectoralis muscle and the bottom part isn’t. Now technically, this is ‘dual plane’, because some of the implant is in the ‘under the muscle’ plane, and some is in the ‘under the breast tissue’ plane. But most plastic surgeons (at least those who are not big on marketing) will simply call this ‘subpectoral’.

When those non marketing surgeons use the term ‘dual plane’ technique, they mean that both a subpectoral pocket and a subglandular pocket are dissected.  The breast tissue is split apart from the pec muscle, which in turn is split apart from the ribcage. The muscle is also dissected so that it is no longer attached to the ribs or sternum (breast bone) as much as it was. This allows the muscle to slide upwards a bit, so that in a dual plane technique less of the implant is covered over by the muscle compared with a subpectoral pocket. The breast tissue which has been split apart from the pec muscle is also more free to ‘move’, and is therefore more able to be ‘stretched out’ evenly and fully by the implant.

Advantages of dual plane breast enlargement.

The critical advantage of dual plane breast augmentation is that it results in a less fake looking top half of the breast, but with a fuller, tighter lower part of the breast. It does this by keeping the top edge of the implant more ‘hidden’ underneath the pec muscle, resulting in less ‘shelf effect’, just like a standard subpectoral placement would. At the same time, the lower part of the implant is subglandular and able to ‘stretch out’ loose skin there that may have been caused by pregnancy or weight loss or bad luck.

It may also be advantageous in cases where stretching out the ‘lower pole’ half of the breast is needed. This is in patients who have a ‘tuberous’ or ‘tubular’ breast shape, or a ‘constricted lower pole’.

So the first thing to understand is that if there’s not any droop, or loose breast skin, or some other unusual shape to the breast to start with, there’s not a whole lot of advantage to using a dual plane technique.

There are other, less important purported advantages, such as less pain, and less animation (movement of the implant when in the gym working your pecs), and less chance of the implant slowly being pushed out of position.

Disadvantages of dual plane breast augmentation.

The main disadvantages are that the surgery takes slightly longer and involves more dissection. I believe this makes the technique slightly less predictable in the hands of an inexperienced surgeon. I think there is also a tendency amongst surgeons to imagine that a ‘dual plane’ is somehow magical and can fix all sorts of loose skin problems whilst not looking fake at all. Consequently they are perhaps not concentrating on the (IMHO) more important decisions about implant size and type as much as they should. Those more fundamental decisions potentially have a much bigger impact on ‘fakeness’ or stretching loose skin etc than using a dual plane technique ever can.

Conclusion.

Beware of any surgeon who says ‘this technique is clearly superior to all others’. If there was one technique that was, truly, clearly superior to all others, every plastic surgeon in the world would be doing it already.

A dual plane breast augment is not necessary in many, many patients. It requires a certain combination of patient anatomy, breast size and shape, added to implant size and type to result in a situation where dual plane augmentation is definitely going to give a better result than either submuscular or subglandular breast augmentation.

Having said that, it may be helpful during a standard submuscular dissection to do some of the extra “dual plane” surgical dissection, but not “all” of it. Some surgeons would still call this operation a ‘dual plane’. Some would not bother to give it a fancy name!

 

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