I recently submitted photo and question in regards to bottoming out or double bubble. If it is double bubble, what would you doctors suggest for revision? Presently they are under the muscle.Should the revision be over the muscle replacement or what else?....and when?I am 9 weeks post op after implant replacements still under muscle, but I have gone from 375 to 275. Thanks...Just want them nice.
Best Solution for a Double Bubble?
Doctor Answers (7)
Correction of Double Bubble Requires Reconstruction of Inframammary Crease or Fold Under Breast
Thank you for your email. Be sure to discuss your concerns with your surgeon.
The double bubble happens when the breast implant pocket is dissected below the Infra mammary Crease-the normal fold beneath your breast. The implant slides down below the fold and the crease appears as a depression or fold beneath your natural breast which rides high on the implant. The implant is visible below the fold and is the second "bubble' the first "bubble" being your natural breast.
Correction of the double bubble requires reconstructing or re attaching the normal Infra mammary Crease to the chest wall by suturing the crease down inside the pocket.
Be sure to see your surgeon for an exam and diagnosis to be certain that you have a double bubble.
Solution for double-bubble
In my experience the only reliable way to create a lasting and controlled reshaping of the breast in cases like double bubble are to convert to a wider implant with less inherent projection and create a beautifully shaped breast by using a cold-subfascial plane. In this way a naturally shaped breast with a secure inferior border can be created. Suture suspensions and capsulorrhaphies are tenuous at best. I hope this helps!
Al the best,
Rian A. Maercks M.D.
Double bubble after breast augmentation
Thank you for the question.
One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).
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 made from the areola to the “new” inframammary fold.
Please make sure you're working with a well-experienced board-certified plastic surgeon.
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If yo uahve a double bubble then the implant has fallen below the fold and it is pushing on it. You need the fold restored with suture suspension.
Fixing double bubble troubles
The double bubble problem is more complex than it may appear and so I would encourage you to get several opinions before deciding how to proceed with the revision. (Visit my website for a detailed article.) If you see the crease across the bottom of the breast (that;s what defines the double bubble) pull upward when you flex your pectoral muscle, then you have a combination problem that includes animation distortion. If that is the case, both things are caused by the muscle pulling on the scar capsule. Thre are two options for correcting that: One is to change to a split muscle plane, the other is a Strattice graft to reconnect the muscle to a new location at the bottom edge of the breast. I would be happy to send you a copy of the article that describes this corection.
Correction of double bubble breast deformity
It is usually best to defer correction of a double bubble deformity for several months after the initial surgery in order to determine whether the condition will persist. Implants may be exchanged for smaller size, the plane may be changed, and a mastopexy may be performed in order to obtain the desirable result.