Hi, Dr. Murray from Absolute Cosmetic here. A common question I get from patients is whether dual plane breast augmentation gives enough support compared to subfascial or fully submuscular placement. Here’s how I think about it.
What Is Dual Plane Breast Augmentation?
Dual plane breast augmentation is when the surgeon cuts the muscle so the implant sits partly above it and partly below it, rather than fully above or fully under.
A lot of people get confused about this, so let’s break it down properly. You’ve got the pectoral muscle sitting over your chest wall. You can place an implant totally above that muscle, totally below it, or you can cut the muscle and let the implant sit half and half, which is dual plane. The upper part of the implant tucks under the muscle and the lower part sits under the breast tissue itself.
How Does Dual Plane Support the Implant?
Dual plane can give the implants some support because the muscle coverage up top combines with a support suture at the bottom, and together they hold the implant in the right position while the patient’s own tissue does the rest.
The tip that most surgeons who do a lot of these will use is a support suture placed low down, at the inframammary fold, to hold the breast tissue and implant in place. People used to nickname this the “internal bra,” but that’s not the used term anymore. Properly, it’s a lower pole support suture, and sometimes a support mesh is used alongside it. That combination holds the implant in place while your body lays down its own scar tissue, which eventually gives additional support of its own.
The doctor who raised concerns in a social media video was talking about subfascial placement, which sits above the muscle but wrapped in a thin layer of fascia (a bit like glad wrap) over the implant. In my clinical experience, subfascial placement, sitting above the muscle with only a thin layer of fascia over it, relies less on muscle support than dual plane does, which is why some surgeons consider it more prone to bottoming out. Individual outcomes vary and depend on the patient’s tissue and anatomy.
What Are the Signs an Implant Isn’t Getting Enough Support?
The main signs of poor implant support are bottoming out, where the implant drops below the natural inframammary fold, and a widening cleavage or double bubble, where you can see a visible step between the natural breast tissue and the implant.
What people forget is that the muscle itself can actually push the implant downward over time, which is what causes bottoming out. It can also push the implant outward toward the sides, giving you that wide cleavage look, or create a double bubble where the fold sits higher than where the implant has settled. Thin tissue coverage can also lead to visible rippling, sometimes called window shading, where you can see the folds of the implant shell through the skin.
How Do Surgeons Prevent Implant Displacement?
Preventing bottoming out and displacement comes down to correct muscle division, a well-placed lower pole support suture, and choosing the right implant size and profile for the patient’s own tissue.
Dual plane reduces the risk of these problems because you’ve got structural support from the muscle above and the support suture below, working together rather than relying on one thin layer of tissue to hold everything up. Getting the muscle release right along the rib is important too, since that’s what determines how much support you actually end up with.
What Are the Treatment Options If Support Fails, From Least to Most Invasive?
If support does fail, the least invasive option is monitoring with a well-fitted compression garment during the early healing period, moving up to revision surgery with a support suture or mesh if the implant has genuinely dropped or shifted.
For minor settling, sometimes simple observation and time is all that’s needed while scar tissue matures. If there’s true bottoming out or double bubble, a revision procedure to reposition the implant and add or replace the support suture, sometimes with mesh reinforcement, is usually the next step. In more significant cases, capsule work is required to rebuild the pocket properly before the implant goes back in. As with any surgery, there are risks involved with revision procedures, including infection, bleeding, and changes in sensation, so it’s worth getting this assessed properly rather than leaving it.
FAQ
Does dual plane breast augmentation hurt more than other placements?
Recovery experience varies from patient to patient, but dual plane generally involves a similar healing timeframe to other placement techniques.
Is dual plane better than subfascial placement?
It depends on the individual. Dual plane combines muscle coverage with a support suture, which many surgeons believe offers more structural support than subfascial’s single layer of fascia. The right placement depends on your own tissue, goals, and anatomy, and this is something to discuss with your surgeon.
What causes an implant to bottom out?
Bottoming out happens when the implant drops below the natural inframammary fold, often because the muscle pushes down on it over time or the lower pole wasn’t supported properly during surgery.
Is the “internal bra” the same as a support suture?
It refers to the same thing, a lower pole support suture sometimes combined with mesh, though that nickname isn’t the preferred clinical term anymore.
Can dual plane still cause complications?
All breast augmentation carries risks including infection, bleeding, changes in sensation, and implant-related complications. Complication rates vary by technique, patient anatomy, and surgeon experience, your surgeon can talk you through what’s relevant to your case.
Is dual plane suitable for very large implants?
It’s still commonly used, but with very large implants the support demands are higher, so your surgeon may discuss additional reinforcement options during your consultation.
Every patient’s anatomy is different, and the right placement and support technique depends on your own tissue, implant size, and goals. If you’d like to talk through your options, get in touch with the team at Absolute Cosmetic and we’ll walk you through what’s right for you.
Disclaimer: This information is general in nature and does not constitute medical advice. All surgical procedures, including breast augmentation, carry risks such as infection, bleeding, changes in nipple sensation, scarring, capsular contracture, or implant rupture. Individual results vary. Please consult with a qualified practitioner to discuss whether this procedure is suitable for you.
