Dual Plane Breast Augmentation: How the Technique Works

Breast size and shape vary widely and can be affected by genetics, hormones, pregnancy, aging and even lifestyle. Breast augmentation is a common procedure that alters breast volume and shape, restores symmetry, or addresses changes due to aging or other factors.

Often referred to as an “internal lift,” dual plane breast augmentation is a cosmetic surgical technique that positions the implant partly beneath the chest muscle and partly beneath the breast tissue. In this approach, the upper section of the implant sits under the pectoral muscle, while the lower section rests directly beneath the breast tissue. This allows the breast and implant to move together more naturally.

This guide will walk you through how the dual plane technique works, how it compares to other placement options, and how to know if you may be a suitable candidate.

What is Dual Plane Breast Augmentation?

Dual plane breast augmentation is a surgical technique that positions a breast implant across two anatomical layers – beneath the chest muscle (pectoralis major) and beneath the breast tissue. The upper portion of the implant sits under the pectoral muscle, while the lower portion rests directly under the breast gland.

This specific positioning gives the procedure its name, “dual plane”, because it utilises two planes within the breast anatomy.

The technique was first described in 2001 as a middle ground between the traditional “under the muscle” and “over the muscle” placements. It combines the benefits of both approaches: the muscle helps cover and support the upper part of the implant, while the lower part sits directly under the breast tissue to create a natural-looking shape and movement.

This method is particularly useful for patients with thinner breast tissue. The muscle layer provides extra coverage, helping to hide implant edges and reduce the chance of visible rippling. The lower placement also improves breast contour and creates a smoother transition from the chest to the breast.

During the procedure, the surgeon carefully creates a pocket for the implant that crosses these two layers. The upper part of the implant is tucked beneath the pectoral muscle, while the lower part lies directly under the breast tissue. This dual positioning allows the breast and implant to move together more naturally.

In Australia, the dual plane technique utilises silicone implants – pre-filled with cohesive gel that feels similar to natural breast tissue and are the most commonly used in Australia. For implant choice, round implants with a softer, cohesive gel are typically used. These implants provide a natural breast contour while maintaining stability within the breast pocket, ensuring a consistent and natural appearance over time.

Read more: How much does breast augmentation cost in Perth?

How Dual Plane Compares to Other Implant Placements

There are three main approaches to breast implant placement: submuscular, subglandular, and dual plane. While each has its place in surgical practice, the dual plane method offers a balanced combination of natural results, reduced complications, and quicker recovery for many patients.

Clinical Benefits of Dual Plane Breast Augmentation

1. Natural upper breast contour: The upper portion of the implant is positioned beneath the pectoralis major muscle. This coverage reduces the visibility of implant edges and creates a smooth transition from the chest wall to the breast. The lower portion of the implant sits under breast tissue, allowing the breast to maintain its natural slope and contour.
2.   Reduced risk of visible rippling in patients with thin tissue: Patients with limited breast tissue are at higher risk of visible rippling or implant edges. Dual plane placement addresses this by providing muscle coverage over the upper portion of the implant, where rippling is most noticeable. Additional techniques, such as fascia flaps, can further protect the implant in thin patients.
3.   Improved implant stability: Muscle coverage in the upper breast helps support the implant and may reduce downward displacement over time. Proper placement within the dual plane pocket provides structural support during daily activities and exercise.
4.   Internal lift for mild breast sagging: The dual plane method can improve mild ptosis (sagging) without additional external incisions. By releasing certain attachments between breast tissue and muscle, the breast can reposition around the implant. This can also address constricted lower poles or tuberous breast shapes. 
5.   Lower risk of capsular contracture: Capsular contracture occurs when scar tissue around the implant hardens. Dual plane placement, with subpectoral coverage, can reduce this risk. Muscle coverage improves blood flow and limits implant irritation, supporting healing and decreasing the likelihood of contracture.

Who is an Ideal Candidate for Dual Plane Surgery?

• Women with thin breast tissue: Dual plane placement is particularly effective for patients with minimal breast tissue who want a natural result. Studies show it works best when the upper breast tissue measures less than 2.0 cm and the tissue along the inner breast (medial pole) is less than 2.5 cm using the pinch test. The upper muscle coverage helps hide implant edges, which is especially helpful for thinner patients. This technique can also correct tuberous breasts or narrow lower poles.
• Women with mild sagging (ptosis): For patients whose breasts show early signs of sagging, dual plane augmentation can provide a subtle internal lift. By adjusting how the implant sits under the muscle and breast tissue, surgeons can improve breast shape and nipple position without additional external scars. This makes it a suitable option for mild ptosis, offering a middle-ground solution between standard augmentation and a full breast lift. Important consideration: It is not a substitute for a full mastopexy (breast lift) in patients with moderate or significant sagging.
• Age, body type, and lifestyle considerations: This technique is generally effective for healthy adults, but active women should consider that partial muscle release may cause temporary chest tightness during vigorous exercise. A professional can provide personalised guidance based on activity levels and body type.

Limitations and alternative approaches

Dual plane augmentation is not ideal for everyone. Patients with significant sagging usually require a formal breast lift along with implants. Women who already have enough breast tissue may achieve good results with subglandular placement, which avoids muscle involvement and can result in a shorter recovery.

The Dual Plane Surgical Technique Explained

Dual plane breast augmentation is a surgical procedure that positions a breast implant partially under the pectoralis major muscle and partially under breast tissue. This technique requires careful planning to optimise implant placement, symmetry, and long-term outcomes. Understanding each step of the procedure helps patients make informed decisions and know what to expect before, during, and after surgery.

1. Incision Locations

An incision is the surgical cut through which the implant is inserted. Surgeons choose the incision site based on patient anatomy, scar visibility, and surgical goals. The primary technique used is:

• Inframammary incision: Made in the fold beneath the breast (inframammary fold). This location allows the surgeon direct access to the pectoralis muscle and the underlying tissue. It provides precise control over the implant pocket, which is the space created to hold the implant.

2. Creating the Dual Plane Pocket

The implant pocket is the space surgically created to hold the breast implant. In dual plane augmentation, the pocket spans two tissue layers: the pectoralis major muscle and the breast tissue.

• Fasciocutaneous flap: A layer of tissue including fascia (connective tissue over the muscle) and skin that is carefully lifted to form part of the pocket.
• Dual plane type 2: The flap extends to the bottom of the areola.
• Dual plane type 3: The flap extends above the areola.

During the procedure, the surgeon selectively releases the lower attachments of the pectoralis muscle while leaving the upper and side connections intact. This allows the upper portion of the implant to sit under the muscle for coverage while the lower portion sits under breast tissue for natural contour.

3. Implant Positioning

Once the pocket is prepared, the implant is placed so that:

• Upper portion: Lies beneath the pectoralis major muscle, which covers the top of the implant and reduces visibility of implant edges.
• Lower portion: Sits under the breast tissue (subglandular), allowing the breast to maintain a natural slope and shape.

This combined positioning provides the benefits of both submuscular (under the muscle) and subglandular (under the breast tissue) placement.

4. Adjusting for Contour and Cleavage

Surgeons assess implant position before closing the incision to ensure symmetry between breasts and optimal aesthetic outcomes. This step allows for:

• Lower pole fill: Ensuring the lower part of the breast is properly shaped.
• Cleavage creation: Adjusting implant placement relative to the chest wall to support natural-looking separation between the breasts.
• Symmetry: Correcting minor differences between breasts for a balanced result.

Recovery and Postoperative Care

Recovery from dual plane breast augmentation is gradual. Full settling, the” drop and fluff” process and scar maturation typically occur up to twelve months.

1. Early Recovery (Days to Weeks 1–4)

• Moderate discomfort, swelling, and tightness in the chest are expected.
• Breasts may appear high and firm initially. This is normal and temporary.
• Pain usually decreases by day 3, though swelling can persist.
• Implants begin “dropping and fluffing” between weeks 2–4 as muscles relax and swelling subsides.

2. Managing Pain, Swelling, and Bruising

• Surgeons provide a pain management plan, which may include prescription pain medications for 3–5 days, anti-inflammatories, and muscle relaxants.
• Cold compresses applied for 15–20 minutes at a time during the first 72 hours can help reduce swelling.
• A surgical compression bra supports healing, minimises swelling, and helps maintain implant position.

3. Activity Guidelines

• Gentle walking can begin within 48 hours.
• Light cardio can resume after 2–3 weeks.
• Chest exercises should be avoided for 6–12 weeks.
• Sleeping in an elevated position is recommended for 2–3 weeks to reduce swelling.
• Desk work is usually possible within 5–7 days, depending on comfort level.

4. Follow-Up and Monitoring

Scheduled follow-up visits typically occur at:

• 1 week
• 1 month
• 3 months
• 6 months

These appointments allow the surgeon to monitor healing, address any concerns, and ensure the implants are settling properly.

Potential Risks & Considerations

As with any surgical procedure, dual plane breast augmentation carries certain risks and considerations:

• Infection: Symptoms may include redness, swelling, warmth, or discharge at the incision site.
• Bleeding or hematoma: A collection of blood around the implant that may require additional treatment or drainage.
• Capsular contracture: The most frequent reason for revision surgery. This occurs when the scar tissue (capsule) that naturally forms around an implant hardens, which can cause breast firmness, pain, or distortion of shape.
• Postoperative discomfort: Patients may experience chest tightness or muscle soreness. These symptoms usually improve over weeks to months.
• Sensory changes: Temporary changes in nipple or breast sensation may occur due to tissue and nerve manipulation during surgery.

Signs of Implant Aging or Complications

Patients should monitor their breasts for changes that may indicate complications:

• Changes in breast shape, firmness, or size.
• Unusual lumps or areas of hardness.
• Breast pain or discomfort.
• Capsular contracture, which may present as firm or distorted breasts.
• Implant rupture, which often shows few or no symptoms but may be detected on imaging.

Final Word On Dual Plane Breast Augmentation

Dual plane breast augmentation is a surgical technique that positions the implant partially under the pectoralis major muscle and partially under breast tissue, providing structural support and improved implant coverage

Recovery occurs progressively, with most patients resuming normal activities within a few weeks. Potential risks, including temporary discomfort, animation deformity, or capsular contracture, should be discussed and understood prior to surgery.

At Absolute Cosmetic in Perth, Dr. Glenn Murray (MED0001196978) frequently performs dual plane breast augmentation, tailored to each patient’s anatomy and goals. To learn more about this technique and discuss your options, book a consultation today.

*The information provided is for informational purposes only and not medical advice. Always consult a qualified healthcare professional before making any medical decisions or undergoing treatments.

Patient outcomes can vary due to factors such as genetics, diet, age, exercise, lifestyle, weight, and overall health. It’s essential to understand that all invasive surgeries come with inherent risks and require a recovery period and specific care regimen.

Detailed information regarding surgical risks and complications is available on our website, but it is advisable to conduct thorough research and obtain a second opinion to ensure you are able to make an informed decision.

Please note that the information provided is general in nature and does not constitute medical advice or establish a doctor-patient relationship. Please be advised that surgical outcomes vary, from patient to patient, and comprehensive research is crucial before making any decisions.