In breast augmentation mammoplasty, there are three basic planes in which the implant can be placed.
They can be
- on top of the muscle
- under the muscle
- dual pocket, which is partly clear of the muscle.
On top of the muscle is also known as a sub-glandular placement or a subfascial placement.
Underneath the muscle is also known as a submuscular or retropectral placement.
The dual plane is a plane in which the muscle covers the upper half of the implant where the chest wall is usually much thinner, and where the implants will be more visible, so the muscle creates cover for that. Whereas the bottom of the implant is left clear of the muscle so that we can get greater expansion in those areas.
Now when would we choose each of those options?
On top of the muscle
A patient that may be suitable for an implant on top of the muscle would have enough of her own breast tissue that the implant can be hidden without needing to go under the muscle.
It is a good position for a patient who is very active because when you place an implant under the muscle, with certain implants, the muscle will tend to push the implants around and create a broadening of the chest or a distortion of the shape with different movements.
The other time you may want an implant on top of the muscle is when your breast is more relaxed or ptotic. We need enough fill from the implant not hindered by a pullback of the muscle to be able to lift and fill the skin. Otherwise, if that patient with a looser breast has an implant placed underneath the muscle, the breast tissue falls on top of the implant and could produce an unwanted appearance.
Underneath the muscle
A submuscular pocket, an implant under the muscle, is an option when a patient is very slim. When you don’t have enough breast tissue, if the implants are placed above the muscle you can see the edges of the implants. The implants become partially visible under the skin.
The dual-plane
A dual-plane is an option that combines the other two. It facilitates better concealment of the implant in the upper part of the breast, but it also allows the bottom part of the breast to be clear of the muscle where it is free to relax and expand and fill out the bottom of the breast.
