How to Avoid Double Bubble?

Is there anything I can do to avoid double bubble deformity after getting breast implants?

Doctor Answers 22

Avoiding a Double Bubble

Thank you for your question.  A double bubble is completely avoidable.  It is important when considering any cosmetic surgical procedure that you consult only board-certified plastic surgeons who are well-experienced in performing the procedure you are electing to have.  A double bubble is commonly the result of placing too large of an implant, in too small of a breast.  When this is done (often because of surgeon inexperience and/or patient demands in sizes) the double bubble is created because you have the bubble of the larger implant and a smaller bubble resting on top, which is the boundary of the patients natural breast.  The best way to avoid getting a double bubble is having a thorough conversation with your surgeon about implant size and your anatomy pre-operatively.  I hope you find this helpful and best of luck!

Woodbury Plastic Surgeon
3.9 out of 5 stars 59 reviews

Avoiding double bubble troubles

Although the common wisdom is that the double bubble contour is related to the original fold of the bottom of the breast creating a tight band when the fold has to be lowered, there is another contributing factor in my experience. This relates to the pectoral muscle being detached which is a routine part of the standard submuscular (dual-plane) technique.

Because the natural attachment of the muscle is higher that the fold, it has to be detached or the implant would sit too high and the breast would be too flat. But this free edge of muscle then ends in front of the breast right where the tight band appears that is characteristic of the double bubble. Contraction of the muscle pulls at that point. There is a way to avoid it using a split muscle technique. More info at the link below--

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 53 reviews

Agree and disagree

Please understand that there are situations where the crease must be lowered to properly position the implant. Obviously, a detailed conversation with the surgeon will outline the pros and cons of doing so - a potential double bubble being one such con.


Robert Frank, MD
Munster Plastic Surgeon
5.0 out of 5 stars 35 reviews

Dual Plane May Be An Option

Dual plane breast augmentation is one of the many options available for patients undergoing breast augmentation surgery.This procedure offers significant benefits for patients with specific anatomic findings and aesthetic goals.It’s not unusual for plastic surgeons to encounter patients who have breast hypoplasia associated with mild breast sag.These patients want larger breasts but don’t want the scarring that’s frequently seen with breast lift surgery.

Under these circumstances, dual plane breast augmentation offers significant advantages.This procedure creates a pocket beneath the pectoralis muscle as well as a separation between muscle and overlying breast tissue.This results in the implants having muscle coverage superiorly and breast tissue covering the implant inferiorly.

This configuration allows the breast tissue to cover the implants in a more natural way.It avoids the need for a breast lift and avoids a snoop dog or double-bubble deformity.In addition, the patient continues to have the advantage of submuscular implant placement including a decreased risk of capsular contracture.

If you’re considering breast augmentation and have mild breast sag you may be an excellent candidate for this procedure.Under these circumstances, it’s important to discuss this issue with your plastic surgeon.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Avoiding the Double Bubble

The main way to avoid the Double Bubble is to stay within the confines of your own anatomy.  When a surgeon chooses breast implants, they take multiple measurements of your anatomy--one of which is the distance from your natural breast fold to the nipple under stretch.  This distance defines a range of implants that will look natural after surgery (ie: the nipple is in the center of the breast volume.)  If for some reason you really want MORE volume, your surgeon might offer to lower your breast fold.  If the breast fold has too much memory, it will not stretch out, and you will be left with the Double Bubble.  If you had agreed to an implant size that your breast was "willing" to accept, you would have natural appearing breasts (possibly smaller than you initially desired.)  Discuss these issues with your surgeon, and come up with a plan that has a risk profile that you are willing to accept.  Personally, I only recommend moving breast folds slightly for symmetry reasons, and do not offer implant sizes that might risk the Double Bubble.


Michael A. Bogdan, MD, FACS
Dallas Plastic Surgeon
4.9 out of 5 stars 67 reviews

The Double Bubble breast deformity

Hi there-

The double bubble breast deformity should be extremely rare with good technique and an experienced surgeon.

The anatomy is well described by my colleagues below-

The best way to prevent this from happening to you, as well as any other complication, and to maximize your safety and chances of being happy, is to do your homework and choose a surgeon well. How to do this? Read on:

In a previous entry, I described how common it is for patients who contact my Orlando plastic surgery center to make the mistake of thinking that:

Anyone offering a plastic surgery procedure MUST be appropriately trained and certified to perform that procedure; this is, unfortunately, not the case.

All plastic surgery training is equal, and so shopping for the best price is the best way to choose a surgeon

In that previous entry, I explained how not all people offering plastic surgery are Board Certified Plastic Surgeons, and in fact, many are not even plastic surgeons! There are now many doctors in other specialties offering to perform plastic surgery procedures without the benefit of the years of training a plastic surgeon receives, convincing their patients that a few weeks of training is sufficient for them to learn what we learn in YEARS.

I explained the potentially dangerous error of choosing based on price.

Finally, I explained how to properly choose not only a surgeon, but also the importance of choosing the facility in which the procedure will be performed and also the anesthesia provider.

For today's entry, we'll assume a healthy understanding of these issues. Having done your homework, and ascertained that the surgeons you are considering are all plastic surgeons Board Certified by The American Board of Plastic Surgery, the facilities in which they operate are all certified by the AAAASF or JCAHO, and the anesthesia providers are all well-qualified, how do you make the final decision?

Here are my recommendations:

Consider the relative quality of the surgeon's medical school educations. While it is true that most medical educations will cover the basics, there is a reason that some institutions grow international reputations and perpetually fight for the best students.

A medical school education among these "Best and Brightest" students and educators could reasonably be expected to produce (and historically has produced) America's finest doctors and surgeons. Ranking lists of medical schools take these things into consideration and are a useful resource. The most respected list, from US News and World Report, can be found here:

Find out where the surgeon completed his/her Plastic Surgery Residency. This is the critical and years long process of going from a medical student to a qualified plastic surgeon, where we learn to do plastic surgery by gradually taking on more responsibility under the watchful eyes of other, already trained and experienced surgeons. Just like medical schools, not all training programs are equal in the breadth, intensity and quality of training offered.

Generally speaking, those programs associated with the best medical schools also provide the best training, as they will be able to attract and retain the best, most experienced and reputable professors of plastic surgery- and the quality of our training will depend on the quality of those training us. For example, I completed my own Plastic Surgery training at Washington University in St. Louis, one of the top 5 medical schools in the United States- and it also happens to be the birthplace of American Plastic Surgery.

It bears repeating that you should be absolutely sure that the surgeon you are considering is Board Certified by The American Board of Plastic Surgery. This is easily done at the Board's site:

Know that surgeons who claim to be "Board Eligible" in plastic surgery are NOT board certified. This may be because they simply have not taken the examinations- but this is doubtfully the true explanation, as The American Board of Plastic Surgery specifically prohibits claiming ANY status with The Board until and unless you have passed all examinations. Much more concerning is the possibility that they were unable to pass the examinations (or simply never took them), but realize they may lose patients if they don't find a way to fool them into thinking they have status with The Board. Are you starting to understand that not all doctors have integrity?

Spend some time thinking about the interactions you have had with the surgeon and his/her staff. You should realize that having a plastic surgery procedure is NOT a singular interaction, like buying a new handbag, in which once the bag is purchased (or the surgery completed) the interaction can be considered to be complete. Rather, you are choosing to enter into a very important relationship with your surgeon, the critical portions of which should be expected to last at least a few months beyond the date of your surgery, as you recover and heal. This very important relationship should therefore be approached with the same care you would give any other... think about whether you think the surgeon will be responsive to your needs and concerns, whether your personalities will allow healthy interaction, the approachability of his/her staff, etc...

Remember- you don't only want to have achieved a great outcome when all is said and done... you want to have had an uplifting and positive experience you can look back on and smile! You can have this in the best practices.

Finally, never forget that what you are really looking for is the very best OUTCOME you can achieve. Sometimes when I'm asked by friends and family how to sort through all the claims some surgeons make of being the best choice because they (the surgeon in question) were voted "the best" by some magazine, or because the surgeon simply says they are "the best", I am reminded of the first Clinton presidential campaign, in which the slogan "It's the economy, stupid" helped Mr. Clinton win the White House. Once you've done the homework outlined above, it's all about the OUTCOME...

Ask to see photos of the surgeon's previous work- and ask yourself if you would be pleased if you looked like the photos they show you. Think about how many good photos they show you. Do most of the outcomes just look funny, with only a few that you think are attractive and natural, or are most of their results pleasing and attractive, even if every one may not be what you specifically want? If the surgeon can't show you at least a few outcomes you find attractive and pleasing, you should look elsewhere.

Be sure to ask directly whether the photos you are being shown are the surgeon's own work (believe it or not, some actually do try to attract patients by showing them the work of others!)

I also always recommend communicating with a few of the surgeon's prior patients who have had the same procedure they are recommending for you. You can ask the surgeon's staff for a list of patients who may have agreed to be called, or find testimonials online at one of the many plastic surgery websites now available. My favorite, because it is objective, free (surgeons cannot pay to be listed higher, so more credibility exists), and allows you to get a feel for the surgeon's manner and personality, is RealSelf:

I know it seems like a huge amount of work, but after you've read this (as well as my prior post) a few times, you'll have a great understanding of the best way to proceed, and it will feel very comfortable and natural to you. Use the resources I've outlined, and use your gut- there are many great surgeons out there- with these guidelines you should be able to attain the outcome and experience you desire.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 159 reviews

Double bubble and breast implants

The double bubble happens when the implant falls below the old fold. The old fold does not stretch out and looks tethered.  This can happen from overdissection of the pocket, and also from a natural progression of the descent of the implant.  Surgery is required to correct this.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

The Double Bubble Breast Augmentation- How it Can be Avoided

The "double bubble"  is a double convex contour in the lower pole of the breast. It occurs when you can see where the natural breast tissue ends and the breast implant begins. This occurs primarily when the infra mammary fold is lowered.  For some patients, lowering the inframmamry fold is the only way to center the implant behind the nipple areola complex. The nipple areola complex must be at or near the center of the breast in order for the augmentation to appear natural.  If you have ever seen images of a woman with breast implants high on the chest and a very unnatural look, sometimes even with very small implants, this is a woman who should have had her infra mammary folds lowered.     

My approach to avoiding the double bubble appearance is two fold 1) Releasing the connective tissue that defines the original inframammary fold. 2) Using an implant (shaped, form stable textured implant) that concentrates implant fullness in the lower pole, thereby producing a more natural- appearing  lower pole contour.  The most recently developed textured surface form stable implants have a high degree of capsular adherence to the textured implant surface. This significantly reduces the possibility of inferior implant displacement (bottoming out) over time. 

A common error that leads to an unnatural appearance after breast augmentation, even with implants of an ideal size, is inadequate lower pole dissection and/or inadequate release of the pectoralis major origin just above the inframammary fold. As a result the implants sit too high and appear excessively full in the upper poles (the area above the nipple-areola complex), while the lower poles - which should be the fullest area of the breast - are underfilled. Inadequate muscle release may also result in bizarre-appearing breast implant animation when the pec major muscle contracts. In some cases this may result in one or both of their implants jumping up literally to the level of a patient's collarbones - an alarmingly unnatural look, and one that is totally avoidable.

Ask your plastic surgeon what steps he takes to prevent bottoming out or avoiding the double bubble experience. All plastic surgeons should have a plan for this 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 120 reviews

Good surgeon will avoid double bubble after breast implants.


The double bubble deformity after breast implants is almost always a technical error. Your surgeon has to plan the right operation for your anatomy, and then create exactly the correct implant pockets.

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

Preventing double bubble

One common reason for a double bubble deformity is placement of an implant that lowers the fold, as Dr. Rand has mentioned, and the old fold retains its memory.

This is particularly a problem when there is a tight (constricted) lower pole and too large of an implant is placed, or when the breast is droopy and no lift is performed.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 178 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.