I am experiencing bottoming out on both breasts. My question is what is the best way to fix this problem? My incisions are about an inch below my natural breast fold. Where would my new incision point be? I would like to go slightly smaller and would like perkier more youthful breasts. My right breast is droopier that I would like. My PS suggested I use strattice to fix my double bubble on my left side and leave the right side alone, do you think this would give me my desired result?
What Are my Options To Correct my Double Bubble? (photo)
Doctor Answers (7)
Options To Correct my Double Bubble
It appears from the photos that the breast fold is intact, and that the implants have not descended below that level. The indentation you can see at rest on the left, and with pectoralis flexion on both sides is caused by the lower edge of the muscle impinging upon the implant and causing the indentation.
If both sides were like the right, I would urge you to do nothing, but since this problem is visible at rest on the left, that merits being addressed, and at the same time the same correction can be done on the less affected left side.
There are a number of techniques, including moving the implants above the muscle, and others that deal with the muscle while maintaining submuscular position.
Strattice is usually a good choice for reconstructing the breast fold when it has been disrupted, but I am not sure that is what is happening here. Discuss with your surgeon. All the best.
How to fix double bubble deformity with breast implants
There are two main causes of double bubble, one of which is when the bottom fold of the breast is high and closer to the nipple (this does not appear to be your issue) and the other is when the pectoral muscle is pulling on the capsule. This is called an animation deformity and you can easily determine if this is the problem by flexing your pectoral muscle. If you see pulling upward where the crease along the lower breast is, then a specific technique called the split muscle method is needed. I will be happy to send you a copy of my article on this.
I feel the best way to fix this problem is to start from scratch. You need to realize that there was loss of support along your breast fold at the time of surgery. Your breast implants thus dropped below the fold. At this point you have a capsule that extends below the fold. A capsule is a thin layer of fibrous tissue that your body forms in response to the implant. It kind of looks like cellofane wrapping paper. In order to correct this problem, many surgeons recommend suturing the two surfaces of this capsule along the fold thus preventing the implants from falling below the breast. The problem with this approach is that even though the surfaces are stitched together, they do not stick. That is why many surgeons recommend using permanent sutures or using dermal matrix grafts to support the repair. Often the permanent sutures do not hold either as they tear through the capsule over time.
I have found that the best way to treat this problem is to get rid of the capsule all together and and work with the natural tissues that are left behind. Normal tissue has the ability to form scar tissue when sutured together so that after a while the surfaces stick together even though the sutures have either absorbed or removed. This is analogous to a skin laceration. After removing the sutures the skin is well healed and will not gape open again.
In summary, I feel your problem can be predictably corrected by performing a complete capsulectomy and reestablishing the inframammary fold using internal suture repair. No costly dermal matrix graft is necessary.
Ary Krau MD FACS
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You have a difficult problem to deal with. Your desire to have smaller, more youthful breast and to correct the double bubble can be addressed with a capsulorrhaphy utilizing Strattice to reinforce the repair. You can forgo the use of Strattice, however this will put you at risk for recurrence of your double bubble. Your current scar will likely lie outside the borders of your breast after the repair. This is the tradeoff for no additional scars on the breast.
Double Bubble Deformity after Breast Augmentation
I would recommend using existing incision site through which the infra mammary fold can be placated to the chest wall with or without acellular dermal matrix reinforcement. Going smaller would also help increase your chances of a better result. I think the two breasts are relatively similar and should be treated in the same manner.
A double bubble can be repaired by performing a capsulorrhaphy. I have done them without strattice but strattice could be used for further reinforcement.
Double Bubble After Breast Augmentation
Thank you for the photos. There several ways to improve your situation. If you want perky breast then you will need to downsize your breast implants and have a lift. An alternate plan would be to soften your internal scar on both breasts to reduce the double bubble. In my opinion STRATTICE has no role in the correction of your situation.