Augmentation with mastopexy is a commonly performed procedure and is done either simultaneously or in stages. The augmentation component can be accomplished by placing an implant in the subglandular, partial submuscular, or subfascial plane, and mastopexy can be performed using periareolar, vertical, or Wise pattern markings. These two components are independent of each other and any pocket can be combined with suitable external markings. The muscle-splitting submuscular biplane is a new pocket and is combined with conventional envelope reductions for mastopexy.

The submuscular biplane pocket was used in 44 consecutive patients for mastopexy and augmentation using vertical scar and periareolar markings. Of these, 13 had subglandular augmentation in the past. The mean age of the patients was 32.4 years (range = 21–46). Average blood loss was 44 g (range = 10–111 g). Drains were used selectively and the procedure was usually done as a day case.

The follow-up period of the included cases ranged from 4 months to 3 years. No infection, hematoma, or wound problems were seen. Minor revision was required for periareolar puckering in one case and three had dog-ears after vertical scar mastopexy. One periareolar mastopexy required conversion into a vertical scar as a revision and one vertical scar mastopexy had superficial infection with bilateral minor skin breakdown which responded completely to antibiotics.

The submuscular biplane technique is a good option for breast augmentation with mastopexy as a single or staged procedure.