I am noticing the formation of a double bubble. Am I Starting to Bottom Out? (photos)

I think I may be bottoming out. I am noticing the formation of a double bubble. What is your opinion and how soon can I have a revision? I had my augmentation 13 weeks ago and I chose 400cc mod-plus silicone implants. Also, if I were to go about 100cc's bigger would it be likely to happen again? I am 5'2" and 110lbs. Thank you in advance for your response.

Doctor Answers 28

Breast Implant Double Bubble or Bottoming Out Repair- Wait 6 months

Thank you for your question. You do appear to have a Breast Implant Double Bubble on your photos.

When this happens you will need a surgical repair of your Inframammary Crease-the fold beneath your natural breast. Double Bubble rarely, if ever, heals on its own.

Of course consult your Plastic Surgeon about repair. Typically repair is done at 6 months after the Breast Augmentation to allow the full extent of the repair required to become fully evident.

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How patient are you?

You clearly demonstrate a small double bubble deformity. This was likely due to the surgeon lowering the infra mammary fold to accommodate the implants. That may improve in time but it also could get worse. You are best served waiting until everything is stable, usually about six months, if not more. The implant will not go up on it's own. Surgery to resuspend the implant is difficult. Putting in a bigger implant or a higher profile implant may correct the pseudo-ptosis appearance but won't raise the implant. As much as you want to do something right now, you would be well advised to wait until everything has settled and you can make decisions about what you want to do.

Peter D. Geldner, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 16 reviews

Your breast implants are not bottoming out.

All breast implants will 'settle' a llittle in time.. Yours look just fine, and I would leave them alone. Going to a larger size sill not improve the appearance, and would be pretty big for your figure.

The 'double bubble' comes from putting large implants into a small breast. Bigger implants will make it worse or make the upper pole too prominent.

G. Gregory Gallico III, MD
Boston Plastic Surgeon
3.5 out of 5 stars 3 reviews

Right size implants for optimal asethetic result

Your implants seem to be bottoming out most likely due to migration of implants downward beyond the natural breast fold.  The solution will be to remove the implants, repair and re-establish the natural breast fold by closure of the lower pockets using heavy, absorvable suture material.  I do not reccomend going to larger size implants at this time because the excess weight of the implants may rupture the repair resulting in reccurrence of your problem.   

Ivan Thomas, MD (retired)
Los Angeles Plastic Surgeon
4.5 out of 5 stars 13 reviews

Settling vs. Bottoming Out

From your photos, it appears that you have had settling of the implants, rather than bottoming out, which will cause the nipples to point too high.

The "double bubble" crease would be made worse by a larger implant. If it disturbs you enough to have further surgery, this can sometimes be improved.  Best to consult your surgeon about that possibility, but allow about 6 months for all the tissues to settle first.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.0 out of 5 stars 14 reviews

Not bigger implants

Your left breast inframammary fold is separated from it's attachments to the rib cage and causing doble bubble. You will need revision and if you bigger the problem will return.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.5 out of 5 stars 67 reviews

Bottoming out?

It looks like you are bottoming out, and you may be better off downsizing and raising the fold back up as well.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Bottoming out

Yes you are bottoming out with a visible double bubble.  This will not self correct and going bigger will make it harder for the repair to work.  It's not that easy..

Implants are moving below your breast crease

It looks like your implants are lower than your breast fold.  You can have this repaired by removing the implant and repairing the inframammary fold.  It would be best to wait about 3 months for swelling to decrease and the implant to settle.  If you decided to increase the size of your implant, the chance of bottoming out or sagging of the breast itself would actually be a little bit higher.  We don't know exactly what size you need to stay below to decrease this risk significantly but a good guess is about 400cc.

Bottoming out

Based on your photo, I see an area on your left breast where your own breast tissue stops that still looks a little "tight" and "band like".  Since your surgery was very recent, it's probably best to wait and see how this goes on it's own.  It may settle with time and massage.

Radial scoring, done internally, of the tight band can help.  Do you know if your surgeon has done this already at the time of your first surgery?  

If after several months, the situation is not better, revision surgery can help.  A larger implant is likely to make the tightness look worse, not better, though.


All the best,

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.