ORIGINAL ARTICLE BREAST Triple-Plane Technique for Breast Augmentation: Solving Animation Deformities Roberto Bracaglia • Damiano Tambasco • Stefano Gentileschi • Marco D’Ettorre Received: 4 December 2012 / Accepted: 12 April 2013 / Published online: 9 May 2013 Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013 Abstract An unpleasant consequence of subpectoral implant placement is the occurrence of animation defor- mities during pectoralis muscle contraction. This study aimed to review the results achieved for 524 patients undergoing the triple-plane technique with respect to loss of animation deformities. The evaluation was performed by a group of three plastic surgeons according to the Spear grading system for breast distortion using a 4-point scale. Of the 524 patients evaluated, 351 (67 %) were rated as grade 1 (no distortion), 156 (29.77 %) as grade 2 (mild distortion), 17 (3 %) as grade 3 (moderate distortion), and 0 (0 %) as 4 (severe distortion).The excellent results achieved can be explained by the horizontal sectioning of the major pectoralis muscle at the areola level to the sternal margin. In fact, it determines that superior to sectioning of the muscle, its activity remains normal, with a low degree of dynamic deformities. On the contrary, inferiorly, at the muscular–aponeurotic plane level, no activity is detected, with no resultant animation deformities. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords Animation deformities Á Breast augmentation Á Triple-plane technique Á Subpectoral implant placement Á Dual plane An unpleasant consequence of subpectoral implant place- ment is the occurrence of animation deformities during pectoralis muscle contraction. The dynamic deformities can be very evident due to upward or downward breast implant displacement. In 2011, the triple-plane technique for breast augmentation was presented [1]. It includes crossing of three different planes by the implant: submuscular in the upper pole under the pectoralis, subglandular in the middle part where the muscle is opened and again submuscular in the lower pole under the caudal end of the pectoralis, external oblique, serratus muscle and the rectus aponeurosis. This study aimed to review the results achieved for 524 patients undergoing the triple-plane technique with respect to loss of animation deformities. Materials and Methods From January 1995 to June 2012, 524 patients underwent breast augmentation by the triple-plane technique [1, 2]. According to this technique, a submuscular pocket was developed in a blunt way through a 5-cm access on the lateral aspect of the muscle. The breast parenchyma was not undermined by pectoralis fascia except for the small surface needed to reach the lateral edge of the muscle to prevent muscular retraction. Once the pocket behind the pectoralis major was real- ized, the serratus muscle, external oblique muscle, and rectus aponeurosis were elevated from the deep plane by blunt dissection. The caudal level of dissection was established according to the level of the inframammary fold to be achieved. After completing the dissection, we performed a horizontal full-thickness incision of the pec- toralis major at the level of the nipple–areola complex from the lateral edge toward the sternum. R. Bracaglia Á D. Tambasco (&) Á S. Gentileschi Á M. D’Ettorre Department of Plastic and Reconstructive Surgery, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy e-mail: damtam@hotmail.it 123 Aesth Plast Surg (2013) 37:715–718 DOI 10.1007/s00266-013-0128-y