Double Bubble Still Present After Revision Surgery?

i had breast augementation 7 months ago, 385 cc after taking the dressing off after one week, i noticed a bulge, after consultation with surgeon found out i had double bubble, he agreed to revision surgery and further enlargement of 120cc to 505cc. one week later after revision surgery, its still there, and does not look any different, i'm very upset, will i need further surgery again?

Doctor Answers 9

Fixing double bubble troubles with breast implants

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There are 2 causes of the double bubble, which typically describes a groove across the lower potion of the breast so there is a bulge above and one below. The groove is often where the original fold at the bottom of the breast was, especially when there was a short distance between the nipple and the bottom of the breast; in that instance, the bottom fold has to be lowered in order to accomadate the implant or it would sit too high. In these cases it is very difficult to fix, and going larger in my opinion is likely to make it worse.

The other cause is when the muscle, which is cut from its attachment to the ribs in a dual-plane submuscular procedure, becomes attached to the scar capsule in front of the implant. If you see pulling up where the groove is when you flex the muscle, then that is the cause. In this case it can be fixed with either converting to a split muscle procedure or a Strattice graft.

One final option which is not especially difficult is fat grafting to fill in the contour, but that won't work if it is related to the muscle animation problem. However, you are still very early after revision surgery so it is wise to let everything heal for a while.

Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Double Bubble Still Present After Revision Surgery?

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I am sorry to hear about the complications you have experienced. The double bubble phenomenon usually represents  a problem along the lower pole of the breasts,  where one can feel/see the breast implant below the “previous” infra mammary fold area. One “bubble” is caused by the breast implant, the other by the breast tissue.

Reconstruction will likely involve the use of sutures to repair the breast implant capsule and reconstruct the inframammary fold areas. The use of additional supporting material such as acellular dermal matrix or biosynthetic mesh may be helpful also.

Make sure that your plastic surgeon has significant/demonstrable experience helping patients with this type of revisionary breast surgery. You may find the attached link helpful to you as you learn more. Best wishes.

Double Bubble Still Present After Revision Surgery?

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Double Bubble Still Present After Revision Surgery? Adding this much larger of an implant certainly contributed, Would you consider downsizing?

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Double Bubble deformity

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Hi there-

Without more information and an examination, it would be very difficult to say for sure what is going on or what needs to be done to correct your problem...

In general, double bubble deformities result from poor planning, execution, and/or technique, and will not correct themselves- surgery will be required.

Double-bubble contour deformity

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I would agree with the need to see and ideally examine this situation to adequately determine what is going on. In general, a larger implant is not a solution to double-bubble contour deformity. It's true that sub-mammary placement of the implant avoids true double-bubble deformity but this has other potential contour problems. I agree with Dr. Baxter's description of what a double-bubble deformity is but I disagree that it's the old inframammary crease. It's also not caused by a dual-plane release of the pectoralis muscle. It's caused by a single plane release of the pectoralis when the new free inferior border of the muscle pulls on the underside of breast (fascia/capsule) in the lower pole of the breast. 

The problem is also aggravated by the slip or stretch of the inframammary crease and is indeed more common when this crease has to be lowered to allow proper positioning of the implant but it's not the only situation where it occurs. 

The correction can and probably should be done with the same implant if it was properly sized to begin with. The pectoralis muscle must be released in the dual (coronal) plane such that its lower border is out of the lower pole of the breast. This is hard to do if the medial border of the muscle has been released too high and may also involve reconstruction of the inframammary crease at the proper level but it doesn't require grafts. In effect, the result means that the implant is submammary in the entire lower half of the breast. 

Unfortunately this is one problem where there seems to be relatively few plastic surgeons who understand what causes the problem and how to correct it. You may need to get another opinion. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Double bubble

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A double bubble can develop with impalnts from the implant falling below the natural breast crease. Often this fold needs to be retacked in place or if purposefuly lowered. then scored to open it up some more. COulnd't ell you what you need without examining you.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Double bubble effect after implants

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My recommendation is to get an opinion from a Plastic Surgeon who is comfortable with submammary placement of the implants. There are MANY Plastic Surgeons who place implants in this position.  When done, there will never be a double bubble effect.  It is a lot cheaper to place them in the submammary position than to spend money on "skin like" materials(, ie:Alloderm ) to try the hold the implant in the submuscular position without a double bubble effect, the release of the muscle may reduce the appearance but may also create more activity related asymmetries & malpositioning.  

The advantages of the submuscular position were primarily seen with the very old silicone implants.  With the new and imporved silicone implants the risk of capsular contracture is no longer reduced significantly by  submuscular positioning of the implant.  There is a slight to moderate increase risk of implant visibility in the submammary position, but I have found this risk to be rarely true.  Also, the appearance and function of a submammary breast implant is overwhelmingly more attractive; natural;  does not create double bubble effect ; and does not result in activity related implant motion & deformity.  

Kimberley Lloyd O'Sullivan, MD
Providence Plastic Surgeon

Double bubble still present after revision surgery

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Really, really need a photo to give an accurate diagnosis. Otherwise, maybe you need a third operation but I would recommend a second opinion in person.

From MIAMI Dr. b

Double bubble defomity

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You can have a double bubble above the nipple or a double bubble below the nipple. Without examining you, it is impossible to answer your question.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

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.