Dual Plane Breast Augmentation
One part of the consultation for patients considering breast augmentation is whether to have the implant on top of or underneath the muscle.
Unfortunately there is an awful lot of hype around cosmetic surgery
…particularly breast implants and I will often hear patients say to me they have heard that on top of the muscle is better or that under the muscle is more natural.
It is not really possible to make these sweeping comments, because the fact of the matter is there are good things and bad things about both.
You need to weigh up the pros and cons and take into account your body type and physique and your lifestyle and hobbies, so that you can come to a balanced and informed decision as to what might be right for you.
Sometimes patients will come to the clinic torn between whether to have them on top of or behind the muscle and they are delighted when they hear about the dual plane technique, but surely this is a compromise between the two with all of the benefits of both.
If someone tells you that one way is the best way to do something or if one type of implant is the best implant, when there are lots of other options available I would advise caution in listening to that advice, because if one was the best, then surely there would be no need for all of the others.
I understand that sometimes it is easier to explain things in terms of what we might recommend, but we should really be giving patients all of the available options to empower them to make the decision as to what might be right.
Broadly speaking, implants can either go on top of the muscle or under the muscle.
There are nuances with both planes, but I do not think the average patient needs to get too worried about the specifics. When they go on top of the muscle they can in either be in a subglandular or a subfascial plane and under the muscle can be a dual plane type I, II, or III.
When I teach and lecture plastic surgeons it is not uncommon for trainees to stand up and be unsure about the exact differences between dual plane type I, II, and III, so it is not something I would expect the average patient to know much about.
The important thing is that all submuscular breast implants are in a dual plane
So in terms of cosmetic breast surgery you can use the term submuscular interchangeably with a dual plane technique.
When the implants are placed under the muscle, it is the pectoralis muscle that is used, but this just covers the upper inner part of the implant. The lower outer part of the implant is only ever covered by breast tissue and so there is always a dual plane.
It is possible to put an implant in a total submuscular plane, but this is only used in breast reconstruction when there is no breast tissue to cover the implant, and so other muscles surrounding the pectoralis major muscle are raised and used to get complete muscle coverage, but this is not a technique that is ever used in cosmetic breast surgery.
The dual plane technique and the different types of dual plane are very useful to the plastic surgeon and the types I, II, and III refer to the amount of subglandular dissection that is performed.
For instance, a type III technique involves making a plane on top of the pectoralis major muscle and freeing the breast off the muscle.
This allows it to hang and sit with the implant in cases where patients have a droop or a sag to their breasts, and the dual plane type III is often the most challenging group of patients. A dual plane type I has got only a limited dissection of the breast tissue off the muscle and is what would be referred to as the classical submuscular plane. Whereas dual plane type II is in between the two.
Therefore, I am sorry to say that dual plane is not a compromise between submuscular and subglandular, it is simply submuscular but called by another name. I am not for a moment suggesting that the dual plane technique is a marketing gimmick because it is a very useful technique and is very well established.
However, I do sometimes hear it being used as if it is somehow better than submuscular because it is in ‘a dual plane’ which somehow sounds better.
Alas it is simply the use of terminology and it remains for you to weigh up the pros and cons of the dual plane or submuscular pocket compared to the subfascial or subglandular pocket.
By all means do your research and ask as many questions as you can think of to help you make a decision about whether you should have your implants on top of or behind the muscle, but do not be blinded or seduced by terminology or a slick sales technique that suggests that one is somehow better than the other.
If you would like a guide on frequently asked questions about breast implants, you can download one below.
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