3 months follow-up developed double bubble in both breast. Was put on anti-depressent to stop the pain in my breast (2 months) have come off of it. My breast still hurt where the crease of the implant and breast meet underneath nipples. 6 month out, hasn't improved, I didnt have any sagging or dropping in my breast. My right breast was constricted, surgeon said he had to stretch the hell out of it. Need advise on what I need to ask my surgeon, and do I need pay for any other surgery?
Pain and Double Bubble 6 Months Post-op
Doctor Answers (8)
Without examining you it is difficult to make recommendations.
If you are having pain, and developing a double bubble, I think the pain can be associated with the movement of the implant to a lower position as it lifts and stretches the tissues. It can be fixed, but there are usually fees. Many surgeons waive the surgeon's fee, but the patient will pay for facility and anesthesia. In our area the cost to the patient would be around $1500 for our patients.
Treatment of "Double Bubble" after Breast Augmentation?
Although best to give you advice after direct physical examination, I think you may benefit from revision of the breast implant pockets (capsulorrhaphy and/or use of acellular dermal matrix). Capsulorraphy involves the use of permanent internal sutures to reconstruct the lower poles of the breasts; this procedure may help to improve the contour of this area.
Consultation with plastic surgeons well-versed with revision breast surgery may be helpful.
Costs of revising a double bubble deformity after implants for constricted breast
Without a consultation or photos it is difficult to provide you with specific advice. However, it is quite common for a surgeon to offer complimentary surgical fees while the patient covers operating room. implant and anesthesia fees.
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Incomplete Tuberous (Constricted) Breast deformity Correction
Regarding: "3 months follow-up developed double bubble in both breast. Was put on anti-depressent to stop the pain in my breast (2 months) have come off of it. My breast still hurt where the crease of the implant and breast meet underneath nipples. 6 month out, hasn't improved, I didnt have any sagging or dropping in my breast. My right breast was constricted, surgeon said he had to stretch the hell out of it. Need advise on what I need to ask my surgeon, and do I need pay for any other surgery?"
Cosmetic Surgery is largely a visual endeavor. Despite your description, it is impossible to render professional advice without an examination, much less photographs. As a result, I will have to confine my comments to generalities.
Tuberous / constricted breast is a challenging entity which presents with a spectrum of partial to complete classical manifestations. Its correction rests fundamentally in complete release of the constrictive fibers that give such breasts the appearance of roots (IE tubers) and led it to be described as a Snoopy Dog Deformity. with all due respect, stretching these fibers does not always work. The surgical cutting and release of the fibers during surgery change the shape of the breast from a tuber to a hemispheric dome which can further be molded and enhanced by a well-chosen breast implant placed underneath it.
The appearance of the deformity at 3 months is most likely a function of the disappearance of swelling and unveiling of the incompletely released breast fold and breast constriction. A revision procedure may be in order.
Dr. Peter Aldea
You have experience "bottoming out" of the implants. This occurs sometimes when the orignal inframammay fold had to be substantially lowered (as in your case). A bottomed out implant not only looks bad, it often feels bad. If your breasts feel a lot better when you support them with the palm of your hand, revisional surgery will likely make them feel much better. The procedure you likely need is a casulorraphy where the bottom part of the pocket is closed off by stitching the capsule shut in the area of the desired inframammary fold.
Discuss this with your surgeon. Whether or not you need to pay all the costs depends on the financial policy of your surgeon. This should have been discussed prior to your implant surgery. Good luck.
Lisa Lynn Sowder, M.D.
Double bubble concerns
It is difficult to assess your situation without photographs of both the preoperative and postoperative views of your breasts. Correction of a constricted breast deformity is a difficult operation and revisions are common. The tight band deformity is usually a result of incomplete release of the constricted breast parenchyma. In a constricted breast (or the more severe tubular breast deformity), correction may require lowering of the inframammary fold, reducing the areolar size, and transecting the constricting bands in the breast. If there is a lack of skin in the lower half of the breast, a two-stage reconstruction using an expander followed by an implant may be required. These operations, although cosmetic in appearance, are reconstructive breast operations at their core.
The term "double bubble" is technically reserved for implants that have fallen below the inframammary fold and create two separate breasts mounds - the native breast, and the lower implant. Correction of this deformity requires properly resetting the location of the implant and reconstructing the inframammary fold. A much different operation.
Things to ask any plastic surgeon before breast surgery are:
- Are you board certified by the American Board of Plastic Surgery (Not the unrecognized Board of Cosmetic Surgery)
- Do you have a lot of experience with constricted breast/tubular breast deformity or revision breast surgery?
- What are the realistic goals that I can expect from surgery?
- If I need a revision, who pays, how much, and what is the office policy?
I wish you the best in your revision. In any revision breast surgery, I recommend getting a second opinion. Many times, this second opinion is the same as your primary surgeon but it may help to improve your confidence in the surgical plan.
Deflating the Double Bubble
Sorry to hear your issue. Whether you have to pay for an revision surgery depends on your plastic surgeon's policy regarding revisions. Pictures would be helpful. The implant may have to be removed and replaced and the breast tissue where it is constricted will have to be reshaped internally. If pain is the main issue two thoughts: (1) consult with a pain management physician or (2) total removal of implants. These are some starting points to discuss with your surgeon.
Double bubble contour irregularity after breast augmentation
Without before and after pictures, it is hard to assess what the problem is. If you had any degree of tubular breast deformity, (constricted lower pole of breast), results can sometimes result in flat lower pole banding at the location of the high, tight inframammary crease. Release of this area is typically done from the inside during pocket creation, but sometimes a flat contour there results which may stretch and improve with time. In addition, oftentimes nipple lift and tightening is performed, and that can correct the double bubble appearance as well. I would have an open, honest discussion with your plastic surgeon, as I am sure they would like a good result for you. It could require a minor touch up in the office or something more involved in the operating room. As far as costs, it depends from surgeon to surgeon on their revision policy. Usually minor touch ups in the office setting can be written off. I can't explain the pain you are having.
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.