The vast majority of patients are happy with their breast augmentation, but when patients do report issues, they sometimes follow a pattern. If you’ve noticed your implants taking on a firm, round look with certain movements or malposition (exacerbated by exercise), or a less-than aesthetic “waterfall” look to the breast, you’re not alone. We spoke to experts about what causes this and what to know about implant placement.
Featured Experts:
- Mark Jewell, MD is a board-certified plastic surgeon in Portland, OR
- Mokhtar Asaadi, MD is a board-certified plastic surgeon in New York
- Raman C. Mahabir, MD, is a board-certified plastic surgeon in Tuscon, AZ
According to Portland, OR plastic surgeon Mark Jewell, MD, certain breast augmentation patients report very similar outcomes. “Patients who have biplanar implant placement report several positional and aesthetic issues,” he says. “This location has been the dogma for years among plastic surgeons, but patients report animation deformities with certain movements and malposition of the implant.”
Biplanar or dual plane is the placement of choice for many experienced surgeons. But like most things plastic surgery, not every approach is right for every patient.
What is a BiPlanar Implant?
First of all, there are a few different ways a breast implant can be placed.
- Submuscular: Under the Muscle, the breast implant is placed below the pectoral muscle.
- Biplanar or Dual Plane, the upper portion of the breast implant is placed under the pectoral muscle, while the lower half sits just under the breast tissue.
- Subglandular: the breast implant is placed behind the breast tissue but above the pectoral muscle.
- Subfascial: the breast implant is placed beneath the thin layer of tissue (called fascia) that covers the pectoral muscle, rather than below the muscle.
Biplanar implants, like the ones Kylie Jenner recently revealed she has, are a common choice these days. New York plastic surgeon Mokhtar Asaadi, MD, says the dual-plane technique creates a natural slope at the top of the breast while allowing fullness and shape at the bottom. “It’s a great option for women who want a natural look that still has volume,” he adds.
But there are some notable drawbacks.
Changing Appearance, Movement and Deformations
“Biplanar implants can lead to animation deformity, where the breasts move and flatten when patients tighten their pectoralis major muscle,” explains Dr. Jewell. “We also see what’s called waterfall deformity, where the implant is held behind the pectoralis major and over time, the breast tissue falls off the implant mound, leading to a sudden drop, waterfall look.”
At the same time, patients report malposition. “The pectoralis major is a very strong muscle and can push the implant down and out laterally where there is no muscle coverage,” Dr. Jewell notes. “That’s something to note for gym enthusiasts who do chest exercises.”
And that firm, ball-like look? That’s a tell-tale sign of having biplanar implant displacement. “When the patient moves certain arm positions, like raising their arms, the breast can look very round and firm,” Dr. Jewell notes.
Embracing Alternate Placement Techniques
These patient reports have led to a slow change among plastic surgeons, shifting their preferred implant placement to other options. Of course, like all things breast augmentation, your surgeon will have to have your unique body in mind to find the best option.
According to Tucson, AZ plastic surgeon Raman C. Mahabir, MD, over-the-muscle (subglandular) placement can be ideal for certain patients, particularly those with adequate natural breast tissue. “Over the muscle can look and feel more natural in the right person,” he explains. “As long as there’s enough tissue to camouflage the implant, it doesn’t move with muscle flexing and avoids some of the issues we see with submuscular placement.”
Another option gaining steam among experts is the subfascial approach.
“The advantage of using a retromammary subfascial approach is that the breast tissue and implant are connected and move together versus being disconnected,” Dr. Jewell explains. “Subfascial location has lesser waterfall and no animation issues. The capsule contracture incidence is roughly the same as biplanar. For most patients in my experience, subfascial is the best option.”
