How Do I Avoid a Double Bubble?

Due to the width of my breasts my surgeon has explained that he would need to (slightly) lower the natural crease of my breast in order to correctly place an anatomical implant. We discussed sub-muscular placement of a polyurethane covered implant but I am concerned about the "double bubble" effect. What can be done to minimise the risk of this happening?

Doctor Answers 11

Double bubble after augmentation

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You ask a great question about preventing a double bubble deformity after augmentation.  This occurs when the inframammary fold is lowered and the previous fold is still present causing a crease between the nipple and bottom of the breast.  I think the term "double crease" would help the patient better understand this problem.

This can be entirely avoided by not lowering the fold.  However, there are circumstances where this would place the implant too high and push the nipple too low and often lowering the fold is cosmetically valuable.  

Salt Lake City Plastic Surgeon
4.9 out of 5 stars 189 reviews

Breast Augmentation with Mini Ultimate Breast Lift avoids the double bubble

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The goal of breast surgery is to produce beautiful breasts.  Lowering the breast is not attractive.  The most attractive breasts are high on the chest wall with upper pole fullness.  I also do not recommend using polyurethane implants.  They were removed off the market in the U.S. about 20 years ago because polyurethan dissolves and patients often get a red rash in the immediate post-operative period.  I recommend a new technique called Breast Augmentation with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to place the implant, raise the breast higher on the chest wall, reshape the breast to increase upper pole fullness and displace the breast more medial to increase cleavage.  By aligning the areola, breast tissue and implant high on the chest wall over the bony prominence it is possible to increase maximum projection with a minimal size implant.  The best implant is the smallest size implant possible.  Silicone gel placed retro-pectoral feel and look more natural than saline.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Lowering Crease and Double Bubble

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    If the crease is not lowered, there will not be a double bubble.  However, there is some subtlety here.  A fold can be lowered through a series of maneuvers without causing a double bubble.  Sometimes crease lowering can be used in a very sophisticated way to correct a number of asymmetries or deformities. 

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Avoiding the double bubble

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The double bubble phenomenon can be avoided by not interrupting the natural inframammary crease. This requires very careful dissection, especially if your surgeon is trying to lower the fold. If there is any doubt that the integrity of the fold has been compromised, your surgeon can place reinforcement sutures to precisely establish the new lowered fold position. Also, conservatively sized implants will lower your risk. 

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 87 reviews

Double bubble prevention

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Careful dissection of the lower pole is done during implant surgery to prevent double bubble deformity.  You might consider that your implant choice isn't quite right for your frame, if your surgeon is telling you the implant you chose won't fit without altering your natural fold.  If you have a very short nipple-to-fold distance, your fold may need to be lowered anyway, though--this is done carefully and conservatively.

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 46 reviews

Double Bubble at Fold of Breast

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Many women with petite breasts have a short distance from the fold at the base of their breast and the nipple.  In these circumstances it is necessary to lower the mammary  fold to have the breast mound in the right location.  The double bubble appearnace is more likely in those who have a very thin layer of tissue beneath the breast on the upper chest wall.  Some times this can be addressed at surgery by releasing a constricting fibrous band at the breast fold. Selecting an implant that is not overly large will decrease the chance of this happening. Difficult cases may require addition of a layer of material, such as Strattice to serve as a support layer for the implant.

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 117 reviews

Lowering the fold

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It is usually not necessary to lower the fold in breast augmentation. Lowering the fold can lead to a double bubble.

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

Usually not necessary to lower the fold in breast augmentation

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The inframammary fold may stretch and lower by itself over time, depending on many factors, but it is not always lowered at surgery.  Anatomic implants usually don't drop much, and the surgeon is careful to precisely create a pocket for it.  Some surgeons purposely lower the fold for large, round implants in small-breasted women.

D`Arcy Honeycutt, MD
Bismarck Plastic Surgeon
4.7 out of 5 stars 24 reviews

Not sure why your fold would need to be lowered because of your breast width

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I usually find that it is best to not alter the fold unless absolutely necessary - this does not have anything to do, however with breast width.

Avoidance of Double Bubble During Breast Augmentation?

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Thank you for the question.  The most important decision you make when it comes to breast augmentation surgery will be selection of plastic surgeon.  Your plastic surgeon will be responsible for developing the breast implant “pocket”;  careful dissection of this pocket will be the key to avoiding a variety of different breast implants malposition problems, including the “double bubble” effect.  If at all possible, it would be best to avoid  dissecting the breast implant pocket below the existing inframammary fold area.

 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.