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Versatility of muscle splitting biplane technique associated with internal mastopexy in breast hypoplasia, ptosis, and asymmetry



Breast augmentation is one of the most highly sought after aesthetic surgeries. For the best outcome, a wide variety of factors such as approach, pocket plane, tissue, and breast characteristics (including asymmetry and ptosis) must be assessed along with the patient’s needs. For patients requiring correction of minor ptosis and breast asymmetry, the current technique involves incisions on the breast, but often the patients are dissatisfied with the visible scars so there is a need for procedures involving less scarring.


Since 2010, 200 patients with breast hypoplasia have undergone muscle splitting biplane breast augmentation; 32 patients with breast hypoplasia combined either with asymmetry or/and minor ptosis have undergone a technique combining muscle splitting biplane breast augmentation with internal suture mastopexy; 12 patients with dynamic breast following partial submuscular breast augmentation have undergone replacement of the implants using the muscle splitting biplane technique.


Satisfactory long-term outcomes were obtained by using muscle splitting breast augmentation, with or without internal suture mastopexy, with more accurate control of the breast’s natural shape, symmetry, and inframammary fold positions as well as proper cleavage and nipple projection. In this way, a smooth transition between the soft tissue and implant in the breast’s upper pole was possible, and more tissue was available to cover the implant’s upper pole. Nipple sensitivity was preserved with no visible scars on the breast.


The muscle splitting biplane breast augmentation offers improved long-term aesthetic outcomes; is extremely versatile, fast, and easy; and may also be used in patients requiring removal and replacement of breast implants. In combination with the internal mastopexy, this technique is an effective alternative in selected patients requiring correction of breast asymmetry and minor ptosis.

Level of Evidence: Level IV, therapeutic study

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Correspondence to Horia R. Siclovan.

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Siclovan, H.R. Versatility of muscle splitting biplane technique associated with internal mastopexy in breast hypoplasia, ptosis, and asymmetry. Eur J Plast Surg 38, 37–42 (2015).

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  • Muscle splitting
  • Biplane
  • Subfascial
  • Submuscular
  • Pocket
  • Internal mastopexy
  • Breast
  • Augmentation
  • Asymmetry
  • Ptosis
  • Implant