Breast Augmentation Bottoming out or Double Bubble Effect?

I am four months post op from breast augmentation. I am able to feel the entire bottom of breast implant at the crease of my breasts. I am scared that way my breasts look I am either having the bottoming out effect or the double bubble effect. Is this an occurence in either complication?

Doctor Answers 21

Let's find out!

Being able to "feel" the implant at the inframammary crease level is normal especially in thin patients and especially with saline implants. This is not bottoming out or a double-bubble.

"Bottoming out" occurs when the implant descends below the crease and the breast loses its fullness in the upper pole as it settles into the lower pole. If you have a crease incision, you will see it riding up onto the lower pole of the breast.

A "double-bubble" occurs when the inframammary crease is lowered to form a new crease farther down and the old crease retains a memory and creates an indentation across the lower pole above where the new crease forms.

Both of these problems can be treated but sometimes they aren't easy to fix.

Breast Implant Bottoming Out Different from Double Bubble

Thank you for your question. Bottoming out refers to the Breast Implant dropping low under the breast and creating the appearance of the breast mound below the Nipple-the Nipple -Areola appears too high on the breast. With Bottoming Out of the Breast Implant however, the Inframammary Crease-the fold beneath your breast is intact.

The Double Bubble Breast Implant occurs when the Inframammary Crease is violated and the Breast Implant slides below the crease. This creates a second area of fullness below the crease on side view-a second bubble. The Inframammary Crease appears on top of this second bulge instead of below the breast as is the normal case.

See your Plastic Surgeon for an exam.

Implant position is important

The implant can be felt along the bottom of the breast without there being a complication.  The shape of the breast will determine whether the implant is at the right level.

Bottoming out

It is not uncommon for the implant to be palpable at the lower portion of the breast - especially in thin patients. If your implant is above your fold you do not have bottoming out or double bubble. If you are concerned about the appearance of your breasts it is best to make a trip to your surgeon's office so that he or she can examine you. 

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.5 out of 5 stars 95 reviews

Follow up with your surgeon

These complications have occured, however it is difficult to diagnosis without an examination. If you are unhappy with your results or if you feel something is wrong or does not look right, you need to contact your doctor. He will examine you and determine if either of these are happening or if you are a thin patient, you will be more likely to feel the implants more than other patients.

If you are unsure about your results dont hesistate to contact your doctor, it is best to address your concerns as soon as possible.

Chia Chi Kao, MD
Los Angeles Plastic Surgeon
3.0 out of 5 stars 3 reviews

You would need to be examined

It's difficult to know without an examination, but both bottoming out or a double bubble can happen after breast augmentation. On the other hand, if you are thin and had saline breast implants, the edges of the implant can be felt (this can sometimes occur with silicone implants, although it's less common).

I would discuss your concerns with the surgeon who performed the procedure, and if needed, seek a second opinion with a Board Certified Plastic Surgeon in your region. If everything is ok, this will at least alleviate your concerns. If not, either problem can be improved, but depending on how severe the problem is, it may not be corrected completely.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 125 reviews

Bottoming out or double bubble?

Inpatients with less tissue coverage over the implant is not uncommon to feel the implant in the lower part of the breast. This feeling does not mean that you are bottoming out or developing a "double bubble". The term bottoming out refers to excessive stretching of the lower breast leaving the upper portion more empty and tilting the nipple areolar complex in an upward direction. A double bubble occurs when a new breast crease is created and the old crease remains. It would be best for year to consult with your plastic surgeon to help you with your concerns. Good luck

John J. Edney, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 90 reviews

Bottoming Out Following Breast Augmentation

         Based on your description I suspect that the origin of your problem is poor soft tissue coverage of your breast implants.  It’s not unusual to be able to feel breast implants, in patients who are thin and have minimal breast tissue.  This can be especially noticeable at the level of the infra mammary fold when saline implants are used.  For this reason, silicone implants in a sub muscular position are usually recommended in women, who have these characteristics.


         When bottoming out and the double bubble phenomena occur, the implants can usually be felt below the level of the inframammary fold.  When these problems occur, aggressive surgical reconstruction is necessary to correct them.


         If you have concerns about palpable implants, discussion with your plastic surgeon is appropriate.  Your surgeon should be able to make a correct diagnosis and formulate a proper treatment plan for you.

Feeling the lower edge of the implant

It sounds like you are just palpating the bottom of the implant.  This is very common with saline filled implants. With a light blot of the fingers you can feel the bottom edge of the implant.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 13 reviews

Bottoming Out of Breast Implants?

Thank you for the question.

It is not common for patients to be able to feel the "the bottom  of the breast implants" when the breast implants have fully settled. This  does not necessarily mean  the breast implants have bottomed out or that there is a double bubble present.

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).

It would be in your best interest to be examined by your plastic surgeon in person.

Best wishes.

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.