Breast Augmentation: Q&A

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What Are my Options to Correct Double Bubble? (photo)

I had my surgery on June 24, 2011. I was a 34A and got 520cc silicone implants. However, at the 3 month mark I started to notice something was off. The incision was under the fold and my surgeon promised that it would not be noticeable, and that this was the only way to fit such a large silicone implant along with lowering my crease, so i trusted him. I now have double bubble and my breast stay raised up in the air, always exposing my incisions. Its been 18 months. What are my options?

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15 Doctor Answers | Asked by CatieChloe

Doctor Answers (15)
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Double Bubble and Correction?

Thank you for the question and picture. I think you are correct, in that your breast implants have displaced inferiorly ( bottomed out). 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... more

What Are my Options to Correct Double Bubble?

I usually try to fix this first by fixating sutures at the bottom and then have patients avoid bouncing or pressure for 6 weeks and wear an underwire bra non-stop. If this does not work I may then go to Strattice, but because of the cost of the product I usually don't go to that as my first choice unless the patient is willing to use it...

Double bubble after breast augmentation

This defect is caused by over dissection of the inferior pocket and needs to be corrected. The inferior fold needs to be recreated and supported, possibly (but not necessarily) with the use of a biologic membrane support. Ask your surgeon about his/her experience with this type of revision. If you are not confident then find a board certified plastic surgeon who knows how to correct this.

Double bubble after large breast augmentation

Your photos do seem to indicate that you have developed a double bubble and bottoming out after large volume breast augmentation. I do feel that this can be corrected surgically, either with the use of an acellular dermal matrix product (Strattice, Flex HD, Alloderm) or without. Both scenarios involve a return to the operating room and supporting stitches in the inframammary region in order to correct the bottoming out and reverse the double bubble changes. The use of the acellular... more

Double bubble

The fold can be raised back up, you may want to consider smaller implants. Some would consider using Strattice for additional support but it is fairly expensive.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Raising the breast implant pockets will put the scars right in the folds.

Hi. This is pretty easy problem to fix. Usually internal stitches will achieve the result. Sometimes , the fold is reinforced with Alloderm if the tissues don't look strong enough. see video

Double bubble

Thank you for your question. You indeed have a double bubble deformity with bottoming out. You had very large implants placed and besides the suture repairs and possibly Strattice placed like other surgeons reccomended, I think you do need to seriously discuss reducing the size of your implants with your surgeon as part of the potential treatment plan. Good luck.

Double bubble and bottoming out

Your photographs show both a double-bubble deformity and bottoming out. The breast implants appear to have migrated below the original inframammary folds, recruiting abdominal skin onto the breasts and becoming visible below the breasts. In general, repair would involve an inferior capsulorraphy (sutures placed at the bottom of the scar tissue envelope that forms around the breast implants) to raise the pockets. The so-called acellular dermal matrices (like Strattice and Alloderm) are... more

Bottomed out implants

Your implants have settled a little too low and this is called bottoming out. It looks like a repair with sutures could fix the problem but requires an experienced surgeon for the best chance of success. Others might use Strattice for a stronger repair but personally I would only use that on you if a suture repair failed.

Double bubble on breast augmentation

I do agree with you that you probably have a double bubble deformity to the breasta, although this is difficult to fully tell about without seeing you in person for an exam. This would be the direct result of going too big with the implant many times. It is certainly correctable, but you may have to decrease the size of the implants slightly, as well as to properly anchor the incision under the breasts so that the scar is directly at the bottom of the breast fold... more

Double bubble after breast augmentation

You indeed appear to have a double bubble deformity. The size of the implant may have contributed to the development of the problem; it may also limit the effectiveness of any repair. Recreating the breast fold (inframammary fold) with internal sutures is a typical first approach to address this issue. Patients never want to hear this, but you may have to consider using smaller implants to put less weight and stress on the repair. Ask your surgeon what can be done... more

How to fix my breasts ?

Your breast width was much wider than distance between nipple and inframammary crease before surgery. Because the implants are round (most of them), your surgeon needed to lower the inframammary crease, OR accept an artificially wide intermammary distance. When the crease is lowered, there can be a visible junction between native breast tissue superficial to the implant and the subcutaneous implant just above the new inframammary fold. To avoid this problem, we sometimes... more

Double bubble breast deformity.

Your identification of the problem is correct, in that you do have a moderate double bubble deformity. This issue aside, you do have a nice result from the breast augmentation surgery. Therefore, treatment should focus on what is good and correcting the lower poles. There are two reasonable options here: one would be to reinsert the correct position of the inframammary fold with sutures into a higher position and the second would be to remove a crescent of inframammary fold skin while... more

Double bubble correction

I agree that you have a double bubble effect. Going from an A cup to your current size is more likely to produce this, in my experience, than a more modest augmentation. The scar itself could be treated to be less noticeable. The left breast is slightly larger than the right and demonstrates the condition with more significance. Certainly you could have a revision with tightening of the breast pocket, or you could choose to do nothing. Secondary surgery always has its own complications... more

Double Bubble

Judging by the photos you do seem to have a "double bubble" which appears to be more noticeable on the left side of the image compared to the other side. This problem involves descent of the breast implant below the original inframammary fold leading to a second bulge under the breast. There are a number of reasons for this. It has made the scar more noticable. Typically this is treated by raising the fold usually with internal stitches. This type of repair needs to be... more