Post Capsulorrhaphy double bubble return. (photos)

BA with 330 silicone unders. Developed double bubble and bottoming out of left breast. 5 months post op I had a Capsulorrhaphy with permanent sutures to rib. As you can see from photos it is returning. My PS is going to remove 1 suture due to causing pain when stretching. He said there is nothing else he can do other than a lift which he said in the beginning I did not need. He offered to remove a wedge of skin on the side to decrease the appearance of the bubble. I am disappointed. Opinions?

Doctor Answers 9

What determines success with capsulorrhaphy

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Successful long-term results with capsule repair depends on the strength of the capsule tissues relative to the weight of the implants. Suturing to the rib will not work if the capsule is thin; it's like sewing tissue paper with rope. That is also the reason why permanent sutures are not more reliable; it's the capsule that provides the support, not the sutures. You can reinforce the capsule with ADM such as Strattice, SERI silk scaffold, or Galaflex mesh. It is also very important to note if there is any animation distortion when you flex. That is another cause/contributing factor to double bubble and requires a different type of repair such as change to split muscle.

Post Capsulorrhaphy double bubble return.

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I am sorry to hear about the complications you have experienced. In my practice, I would likely recommend the use of a two layer suture repair (capsulorraphy)  along with the use of acellular dermal matrix support. If, based on your physical examination, some skin excision along the lower breast poles would be helpful, this should be considered as well.

 Key will be careful selection of plastic surgeon; it will be important that he/she has significant experience helping patients with this type of revisionary breast surgery.   In my opinion, experience really does matter when it comes to successful outcomes. Best wishes.

No lift or skin excision

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I am sorry about your experience with breast augmentation. Your before pictures show mild ptosis but no need for lift. I believe revision of the capsule will fix it in combination with fat grafting. Please see the link

Recurrent bottoming out

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Unfortunately, it's been my experience that simple excision and suturing of the capsule leads to early recurrence of a bottomed out implant. It is necessary to place something at the bottom that stronger and less likely to stretch. In early cases, I can use the back part of the capsule including some of the fascia overlying the rectus muscles to create a flap that begins at the bottom of where I want the implant to sit. Additionally the back part of the old skin can be sutured to the back part of this flap to obliterate the dead space between the two. Also, a small wedge of skin can be removed and leaving a dermal based flap that can be tucked up underneath the other two closures. Skin can then be closed narrowing the distance from the bottom of the areola to the new crease. I call this a three flap technique. Sometimes, the strength of this is still not enough and something stronger than natural tissue called in  ADM, such as Strattice can be added to help bolster the strength of the repair. Your options as I see it is to find a plastic surgeon in your region with a lot of experience in revisionary breast surgery. Best of luck.

Recurrent double bubble

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Dear BAR,   

    Thanks for submitting your before and after pictures . Capsulorrhaphy is a very technical procedure. I do not suture it to the ribs, but rather excise a sleeve of capsule  according to pre operative demarcation and suture the edges of the capsule with multiple interrupted 2-0 Ethibond sutures (permanent suture). This allows for scar formation that hold the implants in the correct position. In your situation, the repair will have to be done from the midline, along the crease and ending at the lateral margin of the pocket. After surgery, my patients wear a bra with a wire 24/7 for 6 weeks for support and allowing a strong scar to form.

   Let me add a side note. You are a prime example for the reason, why I recommend a mini lift (donut, Benneli) in situation like yours - level 2 ptosis, rather than lowering the crease significantly in order to create the impression of perkiness. The later technique positions the breasts low on the chest , which is not youthful and in addition, the stretching of the crease is unpredictable. When the crease is rigid and does not stretch. a double bubble is formed. The mini lift procedure avoids these problems, creating  a youthful and perky breasts.

    Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.

                    Best of luck,

                                        Dr Widder

Capsule repair

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You may need another capsule repair and possible ADM to support it. Often post-op I have patients wear a thong bra as well.

Recurrent double bubble

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I would recommend resuturing the breast implant capsule to correct this.  A lift will lead to more visible scarring.  Also you may consider a slight reduction in implant volume to avoid recurrence.  

Options for Double Bubble

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Thank you for your question and photos. When patients develop problems with implants they have several options for implant exchange and revision. Some patients respond well to this approach while others continue to have problems with implants. In these types of cases we offer implant exchange with fat transfer to provide breast augmentation without implants. The link below will give you more information and show you some examples of patients who have undergone the procedure.

Double bubble

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Hello and thank you for the question and the photos. The double bubble can be a difficult problem to correct. The natural process of healing sometimes allows the implant to settle into a position that is lower than the natural breast border. When that happens you can see the edge of the implant and curved outline. 

The correction is typically tightening of the capsule with sutures, skin revision, implantation of a dermal matrix graft, or switch to texture type implants. I would agree that a lift isn't required. 

The exact answer would require an in person consultation to go over the pros / cons of each option. 

Best to you. 

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.