Is This a Double Bubble and How Can I Correct It?

I have a 2nd BA on 6-9-10 after. Back ground: 4/97 was ~ 34b and had over muscle 360 cc saline 4 pregnancies and BF 6-9-10 2nd BA went to silicone 600 unders with lipo in the larger breast.Since then I have pointed out to my PS that I see a crease or ridge when I lift my arms & now all the time. I go back this week and want to know what my options are to fix it or is this something I notice and will get better with time. I feel like I have waited long enough of the wait and see

Doctor Answers (12)

Double Bubble Deformity Following Breast Augmentation

+2

Yes your pictures do show a “double bubble” deformity. This occurs when the base width of the breast is more narrow (or constricted) and the inframammary crease is tight; therefore it is more commonly a risk in patients with tuberous breast deformity that undergo augmentation. But it is possible in any patient with a tight inframammary crease who undergoes augmentation with an implant diameter larger than the base width of the breast.

You increased the size of your implants quite substantially with your second augmentation and I suspect that the diameter of your new implant is larger than the diameter of your previous implant. Over dissection of the inferior aspect of the pocket can contribute to this as well, since it allows the implant to be positioned lower.  In the presence of a tight inframammary crease, this is exactly what can happen.

If the implant descends blow the level of the inframammary crease just a small amount the “double bubble” may only be seen when a patient lifts her arms up over her head. This stretches the bottom portion of the breast, and pulls the breast tissue up over the implant – the tight inframammary crease now delineates the lower margin of the breast tissue from the lower positioned implant.

The “double bubble” you saw initially was less prominent early on, but became more visible as additional implant settling and stretching of the lower pole breast skin occurred.

If the implant base diameter has been properly selected and does not vary significantly from the width of the breast, surgical correction can usually be achieved by reconstructing (suturing) the inframammary crease at a higher level on the chest wall. If the implant base diameter is too large, this may be difficult to achieve, and a smaller diameter implant may be helpful as well. If the inframammary crease is very tight, complete resolution of the “double bubble” can be difficult to achieve.

Express your concerns to your surgeon so you can discuss your options. Best wishes.
 


Milwaukee Plastic Surgeon
5.0 out of 5 stars 17 reviews

Correcting double bubble deformity

+1

This does appear to be double bubble deformity.  From your pictures it appears that this is due to too much lowering of the inframammary fold.  I have had success correcting such asymmetries by converting to a cold-subfascial plane.  In this way I create a supporting 'internal brassiere' to hold the implant and maintain a beautiful breast shape.  I hope this helps!

 

All the best,

 

Rian A. Maercks M.D.

Rian A. Maercks, MD
Miami Plastic Surgeon
5.0 out of 5 stars 32 reviews

Double bubble

+1

Yes, it looks like you have a double bubble. The implants may be too big for the pocket, and the fold may have been violated in accomodating the implants. 

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

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Breast deformity at 6 weeks - time and massage for now.

+1

The history you give is a bit confusing, but given your photos, you certainly have a crease. If the fold was lowered, then this may certainly be a double bubble. Going to 600cc implants may certainly have required a lowering of the fold. However, there are times after a revision augmentation, particularly if any capsular contracture was present, where a remnant of the old capsule can create an indentation if not released. The dates you provide seem at odds with your description, but if you are within 3 months of surgery the recommendation is time and massage. If no resolution occurs, often a simple release of the tissue is necessary.

 

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 12 reviews

Double Bubble

+1

Your photo's demonstrate a classic double bubble. Several surgical options exist to treat these including raising your present lower fold, releasing the old fold, or camouflage with filler volume.

Marc Schneider, MD
Fort Myers Plastic Surgeon
4.5 out of 5 stars 7 reviews

Double Bubble after breast augmentation

+1

Your photograph demonstrates well the two areas of crease formation on the base of your breast.  It appears as though the higher crease is the edge of your breast at the site of your former inframammary fold and the new fold now sits lower on the chest wall. The area in between shows implant with a thinner covering This finding can happen for a variety of reasons.  If the base of your breast ends sharply, rather than tapering down, the "step off" of breast to upper chest wall skin and subcutaneous fat may be noticeable. An implant that is wider than your breast disc can be difficult to blend in naturally. More coverage of the implant is needed to camaflauge that gap. This can be accomplished with use of materials such as Alloderm or Strattice, two products that are commonly used to solve breast implant problems.  Another option might include fat grating to the fold.  This can increase the thickness of the overlyong soft tissue and create a softer transition.  An examination can help your surgeon know whether or not the constricting band is related to the pectoralis muscle.  If so a release of the lower attachments of that muscle might  improve that area if it bothers you. 

Mary Lee Peters, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 93 reviews

Is This a Double Bubble and How Can I Correct It?

+1

Yes your posted photos show an excellent example of the "double bubble" effect. Revision surgery may improve or try fat grafts to the area or both. Regards 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 62 reviews

Double Bubble Correction

+1

The best way to deal with the double bubble sign is to  raise the infra-mammary fold with what is called an internal capsulloraphy. That should help a lot. Breast implants can migrate and these are one of the risks of the surgery for breast augmentations.

Nothing but the best,

Dr. Lille

Sean T. Lille, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 11 reviews

Fixing double bubble breast implant problem

+1

The double contour that can develop across the lower half of the breast after under muscle implants can relate to 2 factors: One is lowering the original fold, which may be required to depending on the implant diameter, but the other relates to release of the pectoral muscle. If the crease pulls upward when you contract your pectoral muscle, then it is a combination animation deformity and double bubble. There are 2 options for correcting this: if there is enough coverage, you can convert to the split muscle technique (happy to send you details on this) or use a Strattice internal bra. If thre is an animation issue, releasing the band without addressing the muscle pull will only thin the tissues more and not completely correct the problem.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 25 reviews

Double Bubble

+1

Thank you for the question and pictures.

One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).

Yes, it looks like you might have double bubble after your revisionary surgery.   Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. This is corrected by “raising” the inframammary fold using internal sutures. This is done after careful measurements are made from the areola to the “new” inframammary fold.

Another revision may fix it but each surgery has it's own potential risks and complications associated with it.   Make sure you're working with a well experienced board-certified plastic surgeon.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 756 reviews

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.