My doctor didn't say anything about it, but I'm assuming he lowered my fold. I am 6 weeks post op and I have just noticed that there is a noticeable difference between my natural breast tissue and my implant. It seems to be where my natural fold is/was. I haven't started massaging yet (per my doctor's instructions) so I'm wondering if this is something that will go away once they've settled all the way or is this a complication I'm going to need another surgery to fix? I have 650cc saline unders
Will my Natural Breast Blend with my Implant over Time? (photo)
Doctor Answers (16)
Early double-bubble deformity
This is clearly a double-bubble contour deformity and it's too early to reoperate to correct it and it might improve a bit but is unlikely to resolve. Generally at least three months is needed to allow full tissue recovery before considering a correction. Longer may be better and doesn't harm anything.
First I would disagree with not massaging. After two weeks when you are healed and the capsule around the implant is formed, it is better to start massaging to condition the tissues around the implant/capsule. This helps even out the contour but will not avoid a double-bubble or capsule contracture and will not solve it.
I am in a minority on this but I feel strongly that a double bubble is not simply from lowering the inframammary crease and is not the old inframammary crease above the new one. It is possible to lose control of the inframammary crease level whether it is moved or not and properly fitted implants that require lowering the crease level in order to make the distance from the medial edge of the breast to the nipple the same as from the nipple to the inframammary crease do not routinely lead to double-bubble deformity. Control of the inframammary crease level and the lower pole of the breast is best done via an inframammary crease incision and if it wasn't there to start with it will be required to adjust this contour.
In my opinion and experience, a double-bubble deformity is caused by inadequate release of the pectoralis muscle along it's lower edge and sometimes from the connective tissue (fascia) at the end of it which pulls on the lower pole of the breast up to the skin level and causes the problem. If the pectoralis muscle was adequately released in a dual plane out of the lower pole of the breast this shouldn't happen unless there was true fascial constriction of the lower pole of the breast preoperatively. This is aggravated by an implant that had too wide a diameter for the breast width and by losing control of the proper inframammary crease level but is unpredictable and doesn't happen in all such cases.
The correction is through an inframammary crease incision, checking the correct length of the crease-to-nipple dimension and setting the crease there, releasing the pectoralis muscle in two planes out of the entire lower pole of the breast, and making sure there is no fascial restriction of the lower breast tissue by vertical release.
A narrower base width implant might help but may not be required, and ptosis is not the problem and a mastopexy wasn't needed and isn't needed now. Double-bubble deformities are more common in relatively ptotic breasts but it is not clear to me what the key factor is that determines it. I treat all breasts as if this might happen and do all the things I know of to avoid it which include proper sizing of the implant, proper dual-plane release of the pectoralis muscle, and proper control of the inframammary crease level whether it is moved or not. Someone who is unwilling to lower the inframammary fold in a controlled manner for the proper reason is going to have other problems with fitting implants and having them look natural.
Double Bubble after Breast Augmentation will require surgical revision
Thank you for your important question. The implant is below the Inframammary Crease the fold of your natural breast. This is called a Double Bubble and means that the natural breast crease has been separated form its normal attachment to your chest wall.
Fortunately it can be repaired with a straight forward surgical procedure. Typically one would wait at least 3-6 months before attempting this procedure but discuss this with your doctor.
External taping and a support bra can be tried in the meantime but in my experience do not alter the outcome.
Will breast implant visibility resolve? (photo)
This is a difficult situation, and not uncommon. Reasons for visible implant tissue interface are several: Your surgeon probably wanted to avoid scars of mastopexy, so lowered your implants to centralize them rather than raise your nipple-areola complexes (which adds scars at least around the areolae). Also, available breast implants don't come close to matching all breast shapes that women have, so we choose the closest type for augmentation. Often, the base of the implant exceeds the natural breast base dimensions. This means some of the implant is beyond the boundaries of your natural breast. The margin of your elliptical breast as it drapes over the round implant is visible. There are techniques such as radial scoring of breast parenchyma to facilitate better distribution of breast tissue over the implant, but these techniques don't always work well.
At six weeks out, you are still healing. The situation is dynamic. Be sure your surgeon knows what's going on. There are several solutions to this problem, but in my opinion, they all require a secondary procedure if this visible crease persists or worsens.
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A double bubble can happen with larger implants on a small based breast or when the fold is lowered. You will likely need a revision.
Double bubble deformity will require revision surgery in most cases.
As others have stated, this "double bubble" deformity is a result of your own breast tissue and natural inframammary crease being present and visible above your implant pocket and "new" inframammary crease. In other words, your implants are lower than you own crease, and the underside of your breast did not stretch and redrape smoothly over your implant mound.
We have all seen this, and typically it occurs when a woman with some degree of ptosis (breast droop) and breast skin laxity has augmentation alone without breast lifting. As plastic surgeons confronted with your kind of anatomy, we have to decide between augmentation with implants of a size adequate to fill your skin brassiere so that the scars and cost of a lift can be avoided, while trying to deal with a shorter crease-to-nipple distance than is ideal. And nipples that are a bit lower than "ideal."
We can choose to keep the implant pocket at your own inframammary crease and have your mound appear too high and full in the upper pole, with your nipple/areola complex too low (or even pointing down a bit), or we can centralize the pocket behind the nipple/areola complex and try to stretch your natural crease and lower breast skin over the new mound. Most of the time it works; sometimes not. In your case, it didn't.
For now, this needs to soften and heal completely, and while things can be expected to change somewhat, this will not get better in most cases. Re-operation to tighten and raise your pocket is in order, and you and your surgeon can also discuss whether or not smaller implants (or the scars and cost of a breast lift) are to be considered. I usually discuss these potential concerns with "borderline" cases PRIOR to their augmentation surgery, so it is less of a "surprise" when it occurs.
Rest assured that this is not bad or poorly-performed surgery. Rather, this is the consequence of conscious surgical choices made by your surgeon with your specific anatomy to try to give you the best result possible. It usually, but not always, works out. If we had a crystal ball and knew beforehand which patients would have these issues, we would know the solution ahead of time. For now, follow your surgeon's advice and recommendations. Best wishes!
Double Bubble Deformity After Breast Augmentation.
I never consciously try to lower the fold because of the problem you are experiencing, but I have had this happen a few times, as have most of us. Your breast tissue will not blend so the only options are to do nothing or to do a reoperation to recreate the fold and hold the implant up inside your normal breast position. This will of course raise your implants to a point that may look too high to you so you might need to consider a smaller implant. You should wait a few monthe (2-3) before doing anything as the capsular tissue that is used in the repair needs to develop some strength before trying to modify it.
Double bubble is preventable but can happen in breast augmentation
A double bubble, once developed, is not likely to go away on its own. Great care must be taken when lowering the inframammary fold. You will likely need a revision. Please discuss with your surgeon. In the meantime, consider the possibility of wearing an underwire bra to push the implant up and press your fold against your ribs to help define it. Don't do this if your surgeon says not to. Best of Luck.
Double Bubble Not Likely To Improve
My best guess is that your "double bubble" will not improve with time and may well worsen. This is one of the problems with implants which are too large. There also seems to be a higher rate of implant visibility, capsular contracture, and other problems.
Double bubble and a big implant.
Thank you for your photos and your question. It appears that the diameter of your implant exceeds the diameter of your natural breast, so you are seeing a breast sitting on top of the implant or double bubble. It is important to wait until you are further along in your healing because the ultimate implant position is still changing. Share your concerns with your PS and he or she will monitor this with you.
If you require future adustment options may include raising the fold of the breast, possibly with a smaller implant or reshaping the breast so the the natural tissue drapes over the implant better. Your surgeon will be able to go over the options with you.
Breast implants and double bubbles
Your posted photos show that your implants lie below the breast crease especially in the inner half of the crease and especially on the right and the nipples point out at different angles from the midline. I suspect that part of the problem is that the implant base diameters are too wide for your chest. You will likely need revision surgery to repair the creases and replacement of the implants with smaller base diameter implants so that the crease repair is not stressed. If you do the revision too early after the first surgery the risk of ending up with more problems is greater than if you first give the tissue some months to fully recover from the last operation.
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