Breast augmentation: focus on the Dual Plane technique for a natural result

If you have been looking into breast augmentation, you have most probably heard about the DUAL PLANE technique. This technique, also called BIPLANE augmentation, is the most recent technique for inserting breast implants. With DUAL PLANE augmentation, the results are natural even if the implant is round, and more importantly, they age well, which is why it is the treatment of choice I regularly use with my patients.


Reminder about the principle of breast augmentation with implants

When a woman feels that her breasts are too small or inexistent, she can have breast implants inserted to increase the size of her breasts from an A cup to a C cup.

My approach to this very common aesthetic procedure is to always ensure harmony with the rest of the silhouette, and of course, create a natural result with attractive breasts and not the bimbo look often associated with breast implants.

Consequently, the choice of breast implant size and projection, as well as the insertion of the implant will depend on the expectations of my patient, their personality, as well as the size and shape of their bust, the distance between the areolae, the quality of the skin, etc. The aim is to obtain a natural result that ages well both to look at and to touch.

This is why I use the latest generation of implants made of a cohesive, supple silicone gel that is very natural, even to touch. Anatomically shaped implants have been very popular, as they can recreate a naturally-shaped breast, flat on top and droplet or pear-shaped. However, this shape of breast implant has one disadvantage: it can turn around and there is a very rare but non-zero risk of large cell anaplastic lymphoma linked to the texturing of these implants. Round implants currently come in a wide range of sizes and projections to achieve a result very similar to that of an anatomical implant without the disadvantages.

In any case, the shape and size of the implant will be discussed and decided during the consultation according to parameters specific to the patient and the tests carried out with trial implants inserted in a special bra.


Should breast implants be placed in front of or behind the muscle?

For women who wish to increase the size of their breasts, this question is crucial and depends on several factors.

  • Positioning behind the muscle (submuscular)

Insertion behind the pectoral muscle is the most common method simply because women who wish to undergo breast augmentation often have breast hypotrophy (almost inexistent development of the mammary gland). Consequently, insertion under the muscle (and therefore under the skin and the gland) conceals and protects the implant. The result is also natural to touch.

Nevertheless, submuscular insertion has some disadvantages. When the mammary implant is inserted entirely behind the muscle, over time there is a risk of the upper pole being a little too rounded, even as the mammary gland moves downwards due to skin aging and consequently skin sagging. As the implant is held in place by the muscle, it can ultimately look inaesthetic and not very natural with the dissociation of the implant moving up behind the muscle and the mammary gland moving down in front of the muscle.

Furthermore, muscle contractions make the implant visible, can hamper sport, and cause the two implants may move apart in some patients.

  • Positioning in front of the muscle and behind the mammary gland (subglandular)

Two aspects are essential for opting to insert the implant in front of the muscle: the quality of the skin, which must be tonic enough to support the implant, and the quality of the tissues (mammary gland and fat), which must be thick enough to conceal the implant. Consequently, positioning in front of the muscle is proposed to women with an existing bust with sufficiently thick skin and who do not wish for an augmentation that is too large (therefore heavy implant) with the risk of it sagging. In the case of considerable ptosis, a breast lift will be necessary.

The DUAL PLANE technique combines the advantages of these two techniques.


Focus on the DUAL PLANE technique for breast augmentation

To understand this technique well, I like to use the analogy of when you slide under the duvet. Your body (the top of the implant) is under the duvet (the muscle), but your shoulders and head are not.

This technique consists in inserting part of the implant behind the muscle in the upper pole of the breast and behind the mammary gland in the lower pole. The bottom of the implant is therefore no longer held by the muscle.

For a good ten years, this has been the leading technique in terms of breast augmentation and it has numerous advantages as it combines the benefits of each of the techniques while limiting the disadvantages.

With the Dual Plane technique, the muscle is not cut but lifted just like when we slide under the duvet, and the implant is inserted underneath with minimal tissue damage.

 It is placed partly behind the muscle, therefore:

  • The implant is almost completely invisible along the upper edge, its outline cannot be seen
  • The presence of the implant cannot be felt to touch (except sometimes around the edge where the skin is finer)

It is not completely held in place by the muscle, therefore:

  • The implant follows the natural aging of the breast. This technique thus evolves well over time.
  • The curve of the breast, the lower part, is very attractive and natural even if the implant is round
  • The slope of the chest is gentle, attractive, and natural.
  • The breast is little or not deformed, even when the pectoral muscles are contracted
  •  The overall aspect of the breasts, to look at and to touch, is therefore
    extremely natural.

The DUAL PLANE insertion technique is performed via an incision under the breast or around the nipple rather than an incision under the arm. This means it can be hidden under the natural fold of the breast or the tissue of the areolae.

In any case, the insertion technique is chosen depending on the initial shape of your breasts and their size, your morphology (weight, skin quality) but also according to your physical activity, the implant itself, and of course your expectations. I will explain everything openly during the consultation.


A winning combination: implants and lipofilling

For an even more natural result, it is possible to combine the insertion of an implant with the injection of autologous fat, in other words, fat taken from the patient and reinjected into the breasts. It is an ideal combination in slim patients (but with sufficient fat reserves – belly, thighs, hips, knees…) to conceal the implant even more, soften the contours, and add some "softness" to the breasts.


Any questions? Would you like to make an appointment for a consultation with Doctor Rajao in Paris? Contact our team, we are at your service.

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