Do I have a double bubble? Or a muscle flexion deformity? Something is wrong (Photo)

From your photos, what you seeing is a double contour , or " double bubble " . The breast tissue attachment to the muscle is at the top, while the implant contour is below that. It would appear that you have a tubular breast deformity with dilated areolae. This breast shape is difficult to correct with augmentation alone, and is more likely to develope the problem. The appearance generally gets better with time, as the tissues stretch from the weight of the implant. If the problem does not improve, there are revisional surgical procedures that can be performed. Be patient, and follow your surgeons recommendations.

You have both. You have a double bubble = bottom of your implants are lower than your old fold...the fold used to be where your muscle was...and now the old fold is accentuated when you flex your muscle. Based on your photos, you look like you might have had a tuberous breast deformity, which I think is best corrected by placement of implants ABOVE the muscle to really stretch the tight tuberous breast out. Switching your implants to a new location above the muscle would fix this problem. You might also wish consider controlling the slight larger, puffy appearance of your areola with a small periareolar mastopexy. Things to think about. Please always make sure you are in the hands of a plastic surgeon who is board-certified by the American Board of Plastic Surgery. All the best.

The reason I say probably as it depends if you are flexing your muscles when these pictures were taken. If you were, that is pretty common with the implants under the muscle in some patients. But if your pictures are at rest then it does look like a double bubble and there are solutions that I’m sure your surgeon will go over with you.

Hi Callmefancy99,

Thank you for the question and the photo. I understand your concern.

Bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.

Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.

Though rare, some women who undergo breast augmentation will develop a minor deformity known as a “double bubble,” in which additional folds appear underneath the breasts due to the implant accidentally shifting or contracting post-surgery. In most cases, the implant simply slipped too far down the chest wall and traveled behind the breast inframammary crease (the area where the lower breast meets the chest), instead of moving forward to fill the breast cavity. If left untreated, the lopsided implant will form unnatural indentations, resulting in an odd “four-breast effect” rather than the full, rounded chest the patient initially desired.

If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.

Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

Yes, you do have a double bubble deformity.  This is due to you having a mild version of a constricted breast, where the lower pole skin is tight and the nipple/areola is slightly herniated.  With the implant, the inframammary fold was lowered but your natural fold is tight and still visible.  The correction would involve recreating your natural fold with sutures.  A periareolar lift may also be indicated. 

If you're not flexing in these photos, then you have a classic double bubble deformity.  Your PS is right advising you to wait 6 months.  From here, I'd advise you to get a small breast lift and fat grafting to the area to help conceal the double bubble.  

Hi and thank you for the question. It looks like you have a double bubble. Without seeing your preop photos I can't be certain, but it looks like you may have started with constricted breasts where the areolas are low (almost touching the bottom of the breasts/IMF). In these cases it is not uncommon for the surgeon to release the fibers that define the inframammary fold, resulting in the implant dropping and the appearance of the double bubble. The results can be improved but it will take a surgical procedure. Ask your surgeon if he or she has experience correcting it. If not, get a second and third opinion. 
Dr West

Dear Callmefancy99,Your photos indicate that you do have a double bubble deformity.  This is caused when the implnat falls below the released Pectoralis muscle.  3 months out is a bit early to consider revising things even when there is a problem such as yours.  I would have you consider changing the pocket for the implant above the muscle.  this will correct the "bubble" as place the implant in amore anatomic position.  Your areolas are somewhat large as well; you may want to consider a donut mastopexy to reduce them at the tiem of the correction.  Good luck.James Sheridan, MD

Thank you for your question. It look like you have double bubble. You possibly have a constricted/ tight lower pole before surgery. Please continue to follow up with your PS and re evaluate in 2-3 months.