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Figure 5: Sagittal view showing the prosthesis in-situ. Anterior to the Figure 6: Postoperative anterior views of a young woman in (a) relaxed
implant is the superior portion of pectoralis major. Posterior to the position; (b) hands on hips; (c) arms fully abducted; and (d) forced
implant lies pectoralis minor and the inferior portion of pectoralis major contraction of pectoralis showing no dynamic muscle deformity

in the line of its fibres to gain access to the submuscular used to cover the superior pole of the implant has not been
plane as opposed to division of the pectoralis major along shown to cause any significant muscle contraction associated
the infra-mammary fold [Figure 4]. The technique has been deformities as may be the case with total sub muscular or
described for primary [6-9] and secondary procedures. [10-12] dual plane techniques [Figure 6]. In comparison with partial
The technique not only reduces the dynamic deformity due sub muscular or dual plane implant positioning, where the
to absence of muscle release but also has been described muscle is released from the sternocostal margin, the biplane
to correct dynamic deformity associated with partial sub technique has the added advantage of less incidences of
muscular or dual plane augmentation mammoplasty. [13,14] dynamic breast deformity due to absence of the release of
In Muscle splitting Biplane, the pectoralis lies behind and the muscle. [4,13,14] The muscle splitting technique does not
in front of the implant at the same time and without the require division of any of these fibres so that they are still
muscle release [Figure 5]. available for functional use. The communication between
the submuscular and sub glandular sections of the pocket
As Tebbetts has described, the use of a dual plane technique allows one unit feel of the breast. The sub glandular position
reduces the trade-offs commonly seen in subglandular of the implant in the lower pole also allows a more natural
or subpectoral implant placement. With subglandular and three-dimensional results with the implant covered by
placements there is an increased risk of a visible or palpable the muscle in the ever-changing upper part of the breast.
edge of the prosthesis, especially in the upper pole where
there may be insufficient soft tissue coverage. There is also Intact sternal origin of the pectoralis muscle fibres acts as a
possibly an increased risk of capsular contracture leading to fence preventing the implant pockets join over the sternum,
pain or breast deformity. thus, eliminating the risk of synmastia. When sternal
margins of pectoralis are divided in conventional or dual
Although, historically, subpectoral breast implants have plane pockets, the two pockets may communicate over the
been reported as having lower incidences of capsular sternum resulting in synmastia. Subglandular positioning
contracture, the technique is not without its disadvantages. of implant with medial quadrant undermining may result
[5]
There is a higher incidence of implant migration, dynamic in similar complication. The correction of sub glandular
breast deformity and less precise control of breast shape. [1] synmastia can be corrected by simply converting the pocket
in to muscle splitting biplane. To date there have been
[12]
Use of the biplane technique compared with subglandular no cases of synmastia and all of the patients have had an
placement affords more adequate soft tissue coverage in aesthetically pleasing cleavage.
the upper pole with a less stark transition between skin
and implant. A long term review of a large study has shown As the muscle-splitting technique only divides the medial
a 6-7 fold reduction in the over rate of revision surgeries, two-thirds of pectoralis major, this maintains the lateral
when Muscle Splitting Biplane augmentation was compared portion of pectoralis major. The inferior retro-prosthetic
with conventional sub glandular and partial submuscular portion conjoins with the superior pre-prosthetic portion of
augmentation mammoplasty. The submuscular positioning pectoralis major to locks the lateral part of the implant and
[15]
of implants in biplane also offers reduces incidence of helps prevent superior and lateral displacement [Figure 4]. There
[5]
capsular contracture. In our series there have been no have not been any reported cases of implant displacement
cases of capsular contracture so far, however, a larger series or migration in our series.
with well monitored long term follow up will be required for
an actual rate of capsular contracture. In comparison to submuscular implant placement, the
biplane technique affords the same adequacy of soft tissue
The muscular attachment and portion of pectoralis major cover in the superior pole, but in addition better fill and
Plast Aesthet Res || Vol 3 || Issue 1 || Jan 15, 2016 19