I would love some expert advise on how to fix this double bubble I have been experiencing ever since I had my surgery in April of 2012. I am 9 months Post op, 36 years old, and 149 lbs, 5'6". I have 425 cc moderate plus mentor gel implants. My incision is below my natural breast crease, which seems to make this an especially complicated case. I initially had wanted 325 cc implants, so I am also unhappy with the size and would like to have this corrected when I fix the double bubble. My doctor recommended I fix the problem with a crescent or doughnut lift. I feel like this would look very awkward. I would appreciate any advice or feedback! Thank you!
How can I correct my double bubble?
Doctor Answers (10)
Correcting double-bubble deformity
It is not possible to be sure from the single photo but true double-bubble deformity (in my opinion and experience) is not the conventional "wisdom" of the old inframammary crease. It is caused by slippage or stretch of the planned or appropriate inframammary crease level (with a properly sized and positioned implant) and/or the free edge of the pectoralis muscle released from the chest wall but not from the underside of the breast tissue or fascia (connective tissue) in the lower pole. If the pectoralis muscle is released adequately in a dual plane and the inframammary crease level is controlled, this should not happen.
Correction involves proper diagnosis of the cause, but a crescent or donut lift will not help it. I would add that one cannot just choose an implant size and expect it to fit and look right, but changing the agreed upon size of the implant during the surgery suggests a problem in fitting the implant properly which could have affected the inframammary crease level. Unfortunately breast implants cannot be scaled down in width/height easily but the forward profile can be reduced and the tissues will accommodate it.
How to Correct the "Double Bubble" after breast augmentation
The line that you are seeing is where your breast fold USED to be-- it is created by 2 things, tight skin as well as attachments between the muscle and the skin (and of course, placing an implant underneath). There are two ways to fix this problem: one would be to convert the implants to over the muscle. By doing this, the attachments between the muscle and the skin are divided and this line should fade. However, depending on the amount of native breast tissue you have, this might not be a good idea. An alternative plan would be to just go in and surgically divide those attachments (ie, make the surgical plane as if you were going to transfer the implants to a subglandular pocket, but leave them under the muscle. I've seen this a lot, and this is pretty easy to fix. Good luck.
Double bubble deformity
If you are unhappy with your actual size, changing the actual implant with a smaller one and fixing the pocket (suturing the pocket at this level) can improve that double bubble. Another good option is to use fat grafting to disguise the shadow. The fat overfills this area and you should not need any surgery inside.
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The line that you see is your old inframammary crease. I would convert these implants to a subglandular pocket and reconstuct the crease again
Double bubble post augmentation
The issue of a double bubble is due to the pocket extending below the actual fold in your breast. To address this I would perform a neo-subpectoral pocket. I am assuming your implant is under the muscle. This would involve creating a new pocket under the muscle but, in front of the capsule of the old pocket, closing off the old pocket so that the implant cannot get back into that space and reattaching the fold in its normal position. If you want to down size this is a good time to do it as the new pocket can be made narrower to accommodate a smaller implant which would also make this easier to achieve your desired result.
Double Bubble Issue.
First, I do not think a crescent lift will address the issue. Double bubbles occur in women who have a tight fold prior to implant surgery and during implant surgery the position of the fold is lowered. The original distinct fold is still present. A couple of options, to keep the current implant size and try to soften the old fold internally. Second option would be to downside the implant and reset the old fold internally and or the use of a scaffold such as STRATTICE.
Double Bubble After Breast Augmentation
Great question and thanks for asking! Without more pictures from different angles it is difficult to answer your question with any certainty, but I encourage you to seek an opinion from a Board Certified Plastic Surgeon to get an accurate diagnosis and surgical plan. Typically when this problem occurs, it is corrected in the operating room by repairing the original fold in it's natural position using internal sutures. External mastopexy approaches are not going to help alleviate the issue if the fold is riding high on the breast. Best wishes!
A double bubble is created when a doctor tries to lower the fold under the breast or the implant slides downward because the fold has been weakened and can't support the implant adequately. If this has not resolved in nine months then it probably will not resolve on its own. A crescent or donut lift will elevate your nipple/areola but will do nothing to correct the double bubble. Changing implants and going with a smaller volume implant will not correct the double bubble. The only way to correct this, in my opinion, would be to reconstruct your fold back to its original position using stitches inside the breast pocket. If this makes your nipple/areola sit too low then a smaller implant or a crescent/donut lift may help. Restoring the original fold is the first order of business, however.
Smaller Implant after Initial Breast Augmentation
A smaller implant can always be placed. With regard to a lift and the present scar placement, any further advice is hard to provide with the single photo. If you post a frontal view with the camera angle at the level of the breasts as well as profile views, better advice can be offered.
How can I correct my double bubble
There are a number of conditions that are collectively called "double bubble." As the term implies, there are two contours visible, where only one is desired. I think of three separate conditions:
•Patient needing a lift who did not have one, resulting in the native breast tissue sagging off the breast implant, creating two contours.
•Lower margin of the pectoralis muscle creating an impression on the implant causing two contours
•The original breast fold causing an impression on than implant which is positioned lower than the fold.
Each has a separate cause and separate treatment. I don't think the issue here is failure to do a lift, but rather one of the other causes.
I can't tell too much from this photo of just one breast with the arm elevated, and without preop photos. A front and side view of the breasts with the arms at the side would be helpful
When the time comes for correction a small implant will simplify the issues present.
Thank you for your question and for the attached photo. Best wishes.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.