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experience of the surgeon. [4,10] Markings for mastopexy The multilane technique was initially described for
used are independent of the pocket, and choice of the primary cases with a limited experience for ptosis and
pocket can be independent of markings. [4,5] Even though rippling correction in patients following augmentation
breast lies in front of the muscle, most of the patients mammoplasty in subglandular pocket. The concept of
[6]
can have satisfactory breast volume restoration or further the use of the two planes is not new and submuscular
enhancement in partial submuscular pocket. Muscle pocket for implant placement, and subglandular pocket
splitting augmentation is a pocket that can be used dissection for breast envelope draping has been described
primarily where an implant is placed behind the muscle in the past. However, the draping of mobilized breast
in its upper part and front of the muscle in lower part envelope in Multiplane pocket is secured internally while
of the breast pocket. The advantage of this technique is the technique described by Hilton Becker relied on
that the results have a more natural appearance with the external support using dressings and adhesives bandages
advantage of muscle support in the ever-changing upper alone. Becker also used an expander prosthesis with
[22]
breast envelope. [11-14] The use of muscle splitting pocket an occasional combination of periareolar mastopexy in
is also described for secondary procedures where partial certain cases. Similarly, implant site change or pocket
submuscular and subglandular pockets are converted change from subglandular to submuscular, submuscular
into muscle splitting pocket. [15-18] Muscle splitting to neopectoral or subfascial is not new, and the idea has
augmentation allows an immediate natural outcome, been frequently used and documented. Subglandular,
[17]
and the longevity of the results has been reported with dual plane and partial submuscular to muscle splitting
a satisfactory outcome and reduced revision rate when biplane has also been reported for revisionary surgery
compared with other commonly used techniques. with acceptable long-term results in various forms
[19]
The Multiplane technique is a procedure where muscle of aesthetic breast revisionary surgery. [23-25] With the
splitting procedure is used for submuscular implant high number of aesthetic revisionary performed today,
placement and subglandular pocket is used for breast preexisting pockets conversion to muscle splitting biplane
lift or mastopexy. In a previously published article, submuscular pocket, a combination of submuscular and
postoperative suprasternal notch to NACs distance was subglandular pocket, remains a suitable option. The use
reported to be reduced when augmentation mammoplasty of acellular dermal matrix (ADM) in revisionary aesthetic
with multiplane technique distances was compared with breast surgery has introduced another horizon to deal
its preoperative measurements. On the other hand, with various problems encountered in secondary aesthetic
[6]
suprasternal notch to NAC distances was increased breast procedures. In small case series of three patients,
[26]
postoperatively following mammoplasty in subglandular the preemptive use of ADM in lower pole of poor quality
and partial submuscular augmentation, with their breast tissue has been described for internal mastopexy
respective preoperative measurements. The changes and in order to minimize the risk of ptosis in primary cases
[6]
distances are measured more following sub glandular than and in one patient ADM was used for internal mastopexy
sub muscular mammoplasty and are primarily due to the to correct an established ptosis following augmentation
support of an extra muscle layer added to the breast skin mammoplasty with mastopexy. The report is promising,
[27]
envelope when sub muscular pocket is used. In current however, a larger series with longer follow-up will be
[20]
series, average size of the implants used for the initial required to evaluate the efficacy of the technique. In
procedure was 334 mL as compared to 416 mL selected a review article regarding the use of biological and
for the revision cases, a trend normally seen in revision synthetic meshes used in implants surgery, the use of
mammoplasties. [3,21] In revisionary aesthetic mammoplasty, these materials was predominantly limited to breast
patients almost always request for a larger implant size. reconstruction following mastectomy. Even though the use
The larger size of implant used in MIM acts as an internal of ADM has gained some popularity following the safety
splint and put an even pressure on the skin envelope of skin or nipple sparing mastectomies, a high number of
that helps to stabilize the draped skin in this form of seroma, higher infection rate and the cost of the product
mastopexy. This internal splinting is supported by external has restricted its use in aesthetic secondary augmentation
supportive dressings while envelope is settling down in its mammoplasties. The use of long-term synthetic mesh
[28]
relocated position. Since this form of mastopexy does not has shown more promising results in breast reconstructive
involve skin reduction, necessary tightening of the skin and cosmetic surgery, however, the available data of its use
envelope is achieved when a larger implant is used. When in primary or secondary augmentation mammoplasties and
subglandular to muscle splitting submuscular site change augmentation mastopexies are limited. Breast implant
[29]
or pocket changed was performed for rippling alone capsule flaps are reported quite frequently, and various
without an internal mastopexy, and in a patient without techniques have been described for its use in primary
ptosis or skin excess, moderate reduction in implant and secondary cosmetic and reconstructive surgeries with
sizes did not show any untoward skin laxity or puckering, very good results. However, the use of these implants
[30]
when skin envelope finally settled down. However, when flaps, biological matrices and synthetic meshes is limited
a patient presents with breast ptosis and skin envelope to support breast envelope, following mastectomies. These
excess and wishes to choose a smaller implant for alternatives are also aimed to correct implant malposition,
replacement or go down in breast cup size, conventional redefine or reconstruct inframammary crease both in
skin reduction mastopexy with NAC mobilization is the cosmetic, as well as reconstructive surgery. [28-30] The author
recommended procedure of choice. also has described the use of existing capsules to recreate

Plast Aesthet Res || Vol 2 || Issue 3 || May 15, 2015 123