Had implants done two weeks ago and although it is still early I am concerned about a double bubble. My breasts were borderline breast lift material...had sagging, tubular breasts. My doctor created a new crease...now I have a double bubble effect on both of my breasts although the right one is worse. He is hoping that they settle as the left one has already gotten better. He says that if the right one doesn't lower in the next couple of months, I may have to get a lift.
Why Would Someone Get a Breast Lift As Opposed to a Capsulorrhaphy or Capsuloplasty?
Doctor Answers (12)
Breast Procedures: Breast Lift, Capsulorrhapy, Capsulotomy, Breast Augmentation
Breast lift (mastopexy), casulorrhaphy and capsulotomy are separate and distinct procedures. Breast lift (mastopexy is performed to improve ptosis, breast droopiness. It has nothing to due with breast implants whereas casulorrhaphy and capsulotomy procedures are performed after breast augmentation. Capsulorrhaphy and capsulotomy are procedures performed to alter the breast pocket which is performed breast augmentation patients.
Pocket issue vs breast tissue position
A capsullorhaphy repairs a large breast pocket while a breast lift repositions the breast tissue higher up on the chest. A capsulotomy opens the breast pocket. The three procedures address fundamentally different issues. If your implant is properly positioned and your breast tissue is hanging off of your implant a breast lift should be performed to reposition the breast tissue. A capsulotomy to make the implant sit lower on your chest and therefore match the location of your breast tissue will result in lower upper pole fullness and overall your breast will sit lower down on your chest. A bigger problem to correct this will result in a bigger cup size than you want and more weight on a lower positioned fold putting you at risk for bottoming out.
All the best,
Breast augmentation revisions
The key to understanding breast augmentation revisions (or nearly any revision) is, with few exceptions, wait until the tissues have fully recovered and aren't going to change any further. Only then can a proper assessment and operative plan be done to have the highlest likelihood of success with a second procedure. For breast augmentation this is a minimum of three months and may require longer if things are still changing. The second key to revisional breast surgery is to identify exactly what the problem is and what is going to be done to correct that and nothing more. Plastic surgeons should understand this from secondary (revisional) rhinoplasty surgery.
Not much can be assessed at two weeks, but a true double-bubble effect is caused by slipping or stretch of the inframammary crease level and/or pull of the lower end of the pectoralis muscle in the lower part of the breast. This is corrected by correcting the inframammary crease level and getting the pectoralis edge out of the lower half of the breast. There are other deformities that might be called "double-bubble" that require different approaches. A breast lift should not be needed or considered if it wasn't deemed necessary before the original procedure. The key is to identify what didn't heal or settle properly (or wasn't done with the original procedure) and correct it, particularly if that will limit the revision to one side or represent the simplest and most likely to be successful secondary procedure.
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Addressing double bubble with capsulorrhaphy or subfascial correction
I would definitely give it time before even considering revisionary surgery. If things settle out and no double bubble is left, then a periareolar lift might be all that you need. Capsulorrhaphy would be indicated if the position of the implant needed to be changed. In my opinion if this is indeed needed, a better option is to convert to a subfascial plane. Manipulating capsule can give a significant improvement but really relies on weak scar tissue for support. A subfascial plane offers true living structural support and can usually restore a natural appearance.
All the best,
Rian A. Maercks M.D.
Breast Implant Revision - Why Would Someone Get a Breast Lift As Opposed to a Capsulorrhaphy or Capsuloplasty?
These are two entirely different procedures, and it's important to understand what each does. You can, in fact, have or need to have both done, or either one alone. A lift is just what it sounds like - it lifts the breast. In order to do that, though, additional incisions (beyond those required for implants alone or the other procedures) are typically needed, and you may not want to have that done. That's fine, but then you may not be able to get the result you want. The other procedures address the pocket that the implant is in (capsulorraphy) or is a basket term that could describe many different procedures (capsuloplasty, which just means plastic surgery of the capsule). Both more accurately refer to modifications to the space the implant is in than to surgery on the capsule itself or alone, even though that may be required. If it sounds confusing - that's because it is..but at this point I agree that the best course is to see if your implants settle well enough. If not, and additional surgery is required, the key is to figure out exactly what needs to be done, rather than what the procedure recommended should be called.
I hope that this helps, and good luck,
Capsule adjustments are not related to need for a Breast Lift
The two procedures you are asking about would not (in my practice) be interchangeable options for similar problems, but rather would be options for significantly different problems with breast shape.
In other words, capsule adjustments will not obviate the ned for a breast lift if a woman otherwise does need a breast lift, and a woman who would benefit from adjustment of her implant capsules will still need this just a s much after a breast lift.
Your best bet if you are having problems with your breast outcome is to trust that your initial decision on your choice of surgeon was a good one, and that he/she will guide you to your desired outcome over time. It's easy to lose faith, especially if others in your life suggest to you that your surgeon somehow didn't perform for you- but in most cases you will not only not benefit from jumping ship at the first sign of imperfection, but you will actually be harmed over the long term...
Communicate carefully, follow all instructions, never miss an appointment, and trust your Board Certified Plastic Surgeon.
Breast lift or capsule repair?
I know that you have heard this before, but it is important to be patient. It is too soon after surgery to know your final result because implants may take weeks to months to settle.
Typically, a breast lift is performed when the nipple position is low (below the inframammary fold); and a capsulorrhaphy (capsule repair) is performed when the implant is either too low, too far lateral, or too far medial.
I would encourage you to be patient and allow your breasts to settle; and also to discuss options with your surgeon -- whether he would recommend massage or specific straps or bras, etc. Good luck and hang in there!
Lifts vs capsule surgery
It's really too early to tell what's going to happen. I have seen implants take 1-2 months to drop into position. Check with your surgeon and don't panic. Ask if downward massage or an upper breast strap (bandeau) would help. Hang in there.
The indications are different
Each surgical procedure has certain indication and some relative indications. If you are a candidate for the breast lift based on the nipple position and breast position,then capsulectomy or capsule revision will not work.
Breast lift or capsule repair, different issues
There is not a direct relationship between a need for a breast lift or a repair or adjustment of the implant capsule. If the implant sits low or has created a double bubble then capsule repair is the next step. If the nipple sits low and below the point of projection of your breast implant then a lift is needed. The lift will not solve a poorly positioned breast implant.
Best of luck, peterejohnsonmd.com
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