Is It Window Shading with Double Bubble or Bottoming out and Ptosis?

Pre-op:very mild ptosis & lacked volume from breast feeding. Surgeon discouraged me from getting a lift & told me to get overs. During surgery he said overs looked bad & did unders.Post-op left breast hurt verrrrry much & looked snoopy-like. My left breast just keeps getting worse & every time my muscle contracts my breast tissue goes up & the implant moves laterally & down,it so much hurts everyday!How do you fix this? My surgeon doesn't seem to want to mess w/ it nor will I let him personally.

Doctor Answers (9)

Double bubble or bottoming out?

+2

Thanks so much for your question.  It is complicated but it is also very fixable.  You just need to see the right person.  You will likely need to have some type of dermal replacement material (alloderm or stratice) used to correct the current position of the implant.  The implants need to be raised.  The only other option is to remove the implants and allow sufficient time for healing followed by replacement of the implants.  I think the dermal solution is your only high percentage solution at this point.  Hope this helps.  Definitely see board certified plastic surgeons who specialize in revisional breast procedures.


Phoenix Plastic Surgeon
4.5 out of 5 stars 29 reviews

Breast revisionary surgery

+1

Your situation is complex and I am unfortunately not able to give you good advice without direct examination. Its in your best interest to be seen by a board certified plastic surgeon with extensive experience with breast augmentation revisionary surgery. Revisionary surgery is necessary to help improve the appearance of your breasts and may help relieve the pain and discomfort you are describing.

On this site, I do my best to give advice without a physical examination but I want you to know that a physical examination by a board certified physician is always the best way to get the most accurate information.
 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 756 reviews

Is It Window Shading with Double Bubble or Bottoming out and Ptosis?

+1

Even with the posted post operative photos I am afraid you need a staged revisions. Stage I - removal of the implants and allow healing or I might do a L-shaped mastopexy. Stage II - implant insertion, I think sub muscle OK but need to examine. Stage III - any revisions. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 62 reviews

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Window shading and double bubble

+1

Mbear,

You have quite a complicated and difficult problem.  You will need a breast lift on both sides along with release of your breast tissues and possibly reconstruction of your inframammary folds.  Perhaps its time for a second opinion.  Good luck!

Kenneth R. Francis, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 32 reviews

Breast problems

+1

You are definitely getting window shading of the muscle upon flexion.  AS for bottoming out, it is hard to say without an exam. The photos are helpful but do not give the complete story. 

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

I would suggest implant removal and staged reconstruction

+1
I would suggest bilateral implant removal, reattaching the pectoralis muscle and then waiting few months before next stage. The second surgery would involve lift and fat grafting. If you want to be C or D then the third surgery would involve implant placement or more fat grafting. Unfortunately you had difficult case to begin with and the surgery made it more complicated. I have taken care of patients with your problem and you can check my web site for pictures.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
5.0 out of 5 stars 58 reviews

Fixing double bubble/animation deformity

+1

What many patients don't realize is that with the standard dual-plane technique for placing implants under the muscle, the part of the muscle that attaches to the rib cage is cut so that it can slide upa dn open a space for the implant; the cut muscle then heals into the scar capsule as it forms, so when you flex it causes the windowshading that your pictures demonstrate. Often the level where the muscle attaches forms a visible groove across the bottom of the breast which is called a double bubble. There are two good options for correcting this in one stage: The simplest is to convert it to a split muscle plane, and the other to use a Strattice graft. The Strattice option would be preferred if there is a need for coverage and support.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 25 reviews

Correction of post op bottoming out and ptosis

+1

Dear Mbear,  Correction of your bottoming out, ptosis and asymmetry can be challenging. I have  several questions for you,1)how long ago was your surgery, 2)what size and type of implant 3) what were your size and shape goals before the surgery.   Your pictures are very helpful, but there is no substitute for an examination.  There are several things that need to be done.  The implants are bottomed out on both sides, and the pockets need to be  made smaller using sutures.   I would recommend an uplift mostlikely using an inverted T incision because you probably already have an inframammry incision.  The lollipop and inverted T incisions allow a fair amount of  pecision in correcting the droop.The asymetry will need to be improved and it would be helpful to see the pre op photos in this regard.  Finally, new implants would be selected based on your goals for size as well as based on your chest measurements, and placed behind the muscle.  This is usually  performed in one surgery, although touchups are sometimes needed.  Good Luck.

Beverly Friedlander, MD
Short Hills Plastic Surgeon
5.0 out of 5 stars 10 reviews

Revision breast augmentation works.

+1

Hi.

1)  Unfortunately, you have everything that you mention.  This is quite a difficult problem, but it can be fixed!  You don't have to live like this.

2)  Of course I am just going by your pictures, but my first instinct is that you are one of the rare patients that is most successfully done in two stages.  First, the implants are removed and everything is allowed to heal and stabilize for six months.  Then, you can start fresh with a combination lift (circular scar around the areolas which need to be made smaller anyway) and well placed  round, smooth walled  silicone implants.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

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.