For physicians
Dual-Plane Autoprosthesis: surgical technique & anatomical rationale
An autologous tissue reconstruction technique that aims to increase breast projection and upper-pole support without an implant, based on transposition of the inferior dermoglandular pedicle into the subpectoral plane.
This section is intended for healthcare professionals and contains surgical terminology.
Core principle
Two anatomical planes, one load-bearing autoprosthesis
The fundamental principle of the technique is that the inferior dermoglandular pedicle created during mastopexy is placed — with its vascularity preserved — into the potential anatomical plane between the pectoralis major muscle and the chest wall (the subpectoral plane), and fixed there so that it provides internal volume support.
Unlike classic autoprosthesis techniques, this approach does not rely on glandular folding alone but on the combined use of two separate anatomical planes. The autologous volume obtained by glandular reshaping is carried into the subpectoral plane, benefits from muscular support, and creates an additional internal support mechanism beneath the breast parenchyma.
Operative sequence
How the procedure is performed
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01
Individual pedicle planning
The thickness and width of the inferior dermoglandular pedicle are planned individually according to the patient’s breast volume, parenchymal density and vascular anatomy.
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02
Vascularity-preserving dissection
Perforator circulation arising from the internal thoracic and lateral thoracic systems is preserved, while the pedicle is released only to the extent required for safe mobilisation.
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03
Subpectoral pocket & positioning
After careful elevation of the pectoralis major, the autoprosthesis is placed in the subpectoral pocket and positioned so that it supports superior projection and unloads the lower pole.
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04
Internal fixation
The pedicle is fixed with absorbable sutures to the pectoralis major fascia or to appropriate anatomical fixation points, minimising the risk of migration and rotation.
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05
Parenchymal reshaping & closure
The breast parenchyma is then reshaped, the medial and lateral glandular pillars are adapted to create the anatomical contour, and skin resection is completed according to the planned mastopexy technique.
Surgical philosophy
From folded gland to load-bearing internal support
The essential biomechanical aim of the technique is to convert the glandular volume of the lower pole into a load-bearing internal support unit, rather than merely folding it.
Through its subpectoral position, the autoprosthesis is intended to:
- Benefit from the dynamic support of the pectoralis major muscle
- Contribute to preservation of upper-pole projection
- Reduce the effect of gravity on the lower pole
- Distribute parenchymal load more evenly
- Support long-term shape stability
In this respect the technique is not merely a mastopexy method; it can be regarded as an approach of internal parenchymal reconstruction and biological autoaugmentation performed with autologous tissue.
Indications
Patient groups in which the technique may be considered
- Regnault Grade II–III breast ptosis
- Postpartum or weight-loss related upper-pole volume loss
- Autoaugmentation candidates who do not want an implant
- Patients with sufficient inferior parenchymal volume
- Primary mastopexy or selected secondary cases
Potential advantages
What the approach aims to offer
Theoretically, this approach:
- Provides autoaugmentation with autologous tissue
- Aims to support superior fullness without an implant
- May help preserve long-term projection by creating internal parenchymal support
- Eliminates implant-related complications
- Combines mastopexy and autoaugmentation in a single session
- Offers an anatomical reconstruction that makes use of soft-tissue biomechanics
Clinical evidence
A published, peer-reviewed technique
The Dual-Plane Autoprosthesis Technique was developed and published by Op. Dr. Umut Zereyak in the journal Aesthetic Plastic Surgery (2026), and presented at the ISAPS Olympiad World Congress 2025 in Singapore.
Aesthetic Plastic Surgery · 2026 · ISAPSpatients in the published study
BREAST-Q breast satisfaction (before → after)
BREAST-Q outcome satisfaction score
minimum follow-up, upper-pole fullness sustained
- Upper-pole fullness significantly improved at 12 months, confirmed by ultrasound
- No loss of nipple–areola sensation reported
- No implants and no mesh — your own tissue provides the volume
Zereyak U, Aksoy O. Subpectoral Breast Fixation with Dermoglandular Inferior Pedicle: The “Dual Plane Autoprosthesis Technique.” Aesthetic Plastic Surgery, 2026.
Read the publication →Scientific publication
A peer-reviewed technique
Following its development, the Dual-Plane Autoprosthesis (Zereyak Autoprosthesis™) was evaluated together with its clinical outcomes and published in the international peer-reviewed journal Aesthetic Plastic Surgery (APS), contributing it to the aesthetic breast surgery literature.
Scientific publication demonstrates that the surgical approach rests not only on clinical experience, but on data that has passed through international academic review.
Learn the technique from its developer
The Zereyak Fellowship Program offers plastic surgeons hands-on observership and advanced training in the Dual-Plane Autoprosthesis™ technique.
Explore the Fellowship Program