What can be done to minimize the risk of snoopy/double bubble?
You do not include a photo, so I have no idea what degree of breast sagging you have. Breast implants will not lift breasts, they will only fill out breasts where they are. AND, if the breast is hanging too low below the inframammary crease, it will hang off of the implant ad create a "double bubble" or "snoopy" breast. There are some cases of low hanging breasts, within reason, where a dual plane technique will allow a patient to avoid a breast lift and the implant will fill out the breast...NOT lift the nipple, but result in a reasonable result without the breast hanging off of the implant. Some surgeons believe that placing the implant in a subglandular plane (above the muscle) will allow the implant to fill out a loose skin sagging breast better, but with a dual plane technique we still can get better coverage over the implant in the upper pole (to reduce the risks of visible implant wrinkling), a lower risk of capsular contracture, and an implant that holds its position better than implants in the subglandular plane while still filling out a loose skin envelope. The mistake is to place a larger implant than you feel comfortable with in order to avoid a breast lift if, in fact, that is actually what you need. Most likely you will end up returning with a loose, hanging breast that falls off of the implant, an unsatisfactory shape, an implant in the subglandular plane that has a more stretching effect on your tissues, and require a more complicated and expensive surgery to fix things. Again, all of this depends on the extent of your breast sagging. If you are uncertain, get a second opinion.
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What can be done to minimize the risk of snoopy/double bubble and bottoming out
Bottoming out is determined by your soft tissue characteristics. heavier implants are moe likely to bottom out. The avoidance of a double bubble is up to the skill of your surgeon.
Minimiza risk of snoopy or double bubble
That would be my choice too. Even I have not see your pictures I will recommend you to use 430 cc, because less weight and least probability of bottoming and also change the smooth for a texturized, because this also low rates of capsule formation.
Best regards and Good luck.
Dr. Silvia Aviles
Dominican Certified Plastic Surgeon
You already have made the decisions about size and pocket position!
You just need to have your surgeon do a great job and heal as well as possible.Please find an experienced Board Certified Plastic Surgeon and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all aspects of facial surgery, breast augmentation and body procedures including tummy tucks or mommy makeovers