I am two weeks post op from TABA with silicone 300/325cc unders (34 maybe-a-B preop)and since surgery I have had what looks like a double bubble. It seems to be getting a bit worse. I have been wearing an underwire full coverage bra since sx. Is there anything I can do to prevent further dropping of the implant and if it needs surgical revision...what is the best method? How much do these revisions usually cost if performed by another physician?
Way to Stop Dropping of Silicone Implant?
Doctor Answers (12)
Breast Augmentation problems
Thanks for the question.
I do agree with Dr. Rand that it may be too early to be looking at revision. However, I would add that typically early issues like double bubble or low riding implants are less likely to improve over time, than issues of the implants riding a little high or small asymmetries.
Double bubble deformity can be caused from breast augmentations in patients that also needed a breast lift (think of the implant being in a correct position to augment your breasts but your breast tissue being positioned inferiorly). Contstricted or tuberous breasts can also have this problem and require special scoring and pocket shaping techniques.
Your best option is to give yourself 3 - 6 months to heal - you may have improvement in shape and contour. Stay in close contact with your plastic surgeon and advise him or her of your concerns. If you still have problems discuss revision with your original surgeon or another board certified plastic surgeon.
I hope this helps.
Correction of silicone breast implant double bubble
Although there is a chance that reduction in swelling and use of supportive bras may help reverse the double bubble, ultimately, this is best corrected in several months when the capsule has established around the implant. I would recommend repositioning of the implant with capsule plication and possible skin mastopexy.
Transabdominal breast augmentation problem
Transabdominal breast augmentation is a great way to avoid scars on the breast when desiring a breast augmentation at the same time as a tummy tuck. Of course not everyone is a candidate. As to the double bubble question. This may have occurred with the descent of the implants. The best thing to do is wear a support garment along the breast fold. This may improve. If it does not, then talk to your doctor. You may need a revisoin from a more traditional approach.
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TUBA or not TUBA
Unfortunately, you have experienced one of the complications of working on the breasts from the belly button. The farther away from the breasts you are, the less control you have in positioning the implants. If it was a plastic surgeon that did the work, you should return to him/her for correction. He/she will likely offer to fix it free of charge. If money is no object and you have absolutely no faith in your surgeon's abilities, you can see a board certified plastic surgeon. You will likely need an incision in the lower breast fold to reposition the implant and reconstruct the fold. Don't be surprised if you need both sides worked on for symmetry. If the bra is holding the implant up in good position continue to wear it around the clock until you see a plastic surgeon. Good luck!
Options for dropping silicone implants limited at this time
I feel that the best thing to do is to continue with the support provided by the bra. Be very careful that the underwire doesn't cause pressure sores in areas where sensation is reduced from surgery.
Immediate surgery is an option, but I don't feel the best option. I would work with your surgeon, and follow up regularly. I would usually suggest, based on exam, to wait 6, 9, 12 months depending on healing. Sometimes these double bubbles work themselves out as the tissues relax.
I also feel the need to reassure you at this point. I tell my patients that you really can't get a good idea of what the final result will look like until about 3-4 weeks after the procedure due to the swelling and spasm, and this is true. Try to keep calm.
If you do need surgery, assess if you want to go with your current surgeon or not. Confidence is key to the doctor patient relationship.
Mal-position of implant
I am assuming the double bubble you see in on the undersurface of the breast at the inframammary fold and not on the upper surface of the breast. Although there is some possibility prolonged use of an underwire compression can "reverse" inferior malposition of the implant, it also depends on why the implants are malpositioned to begin with. If the pocket was inadequately dissected superiorly with the entire pocket being located too low, especially if there was inadequate release of the pectoralis major muscle as well, the implant will continue to sit too low relative to your overlying breast tissue. If you press upwards on the bottom side of the implant and cannot get the implant to sit in its appropriate postion, there is an inadequate pocket.
If the pocket is adequately dissected but excessively so below the inframammary fold, then the underwire compression may help in correcting the malposition or preventing further descent. You should be able to push on the implant to get it to sit higher in its appropriate position.
Another possibility is that the pocket is dissected as needed, centered behind the nipple, but the implant is simply too large or wide for your native breast. In this case, the upper portion of your breast should look quite appropriate but the implant will poke out below your lower breast.
As you might guess, correction of these malpositions will demand different solutions, some easier than others. Often, the correction of augmentation is more expensive than the primary augmentation itself.
Unfortunately, this is not going to get better.
Hi. The options are to revise this immediately, or to wait at least 6 months. Without seeing you, I would say wait. In the mean time, just wear a comfortable bra. I don't think anything external will help.
The best way to revise this is with a short incision in the fold under the breasts. This way, the contour deformity can be repaired directly and securely (this is not necessarily easy).
Fees vary a lot with each community. So this is just a guess. The cost to you for a revision might be at least $8000.
Continue to wear that bra
A double bubble visible early in a breast augmentation, in my experience, is unlikely to completely resolve. However, you are early enough that I think wearing that underwire bra for another month is indicated. Keep your surgeon posted of your concerns and ask him what his experience is in being able to correct it with the bra.
If you do need a revision, I believe you will need a different incision than the trans-axillary approach that you had (I assume that is what you mean by TABA). If the inframammary fold was lowered too far, it may take re-establishment of that fold through a periareolar or inframammary approach. This is a successful treatment, yet it is not as easy as it may sound. Your surgeon has every interest in making you better so keep in touch.
If you were to go to a different surgeon for the revision, the cost would be significant as that surgeon enters into a difficult situation that was not his/hers to begin with.
Unlikely to improve
If the implant is already too low only two weeks after surgery, it is unlikely that it will improve. It might even get a little worse as the tissues start to relax.
This can be repaired with internal sutures, and most Plastic surgeons are familiar with this problem. Cost will certainly depend on which part of the country you are in, and the skill level of the surgeon. It will most likely require an incision in the crease under the breast to get optimal results.
Your best bet is to consult with the surgeon who put them in, unless you have lost confidence in him. You should feel comfortable with your choice. Best of luck.
TABA and inframammary fold lowering
Given the fact that a transabdominal breast augmentation (TABA) involves placing the implant through the upper part of a tummy tuck flap, and it is not performed by a great deal of plastic surgeons, I would recommend you return to see your surgeon if you are experiencing double bubble and IMF lowering at only 2 weeks out.
The inframammary fold attachments may be weakened or possibly disrupted by this approach if you are experiencing issues this early. Ask a surgeon who is an expert at this particular procedure for a second opinion as well. Dr. Steve Wallach on this site has pioneered this procedure.