Will I have a "double bubble" issue w/submuscular placement? Which placement or treatment will be best for my tuberous breast?

Hello and Great Question.  I appreciate the time you are spending researching this procedure.  My name is Dr. Matthew J. Nykiel.  I am a Board Certified Plastic Surgeon, a Fellowship Trained Cosmetic Surgeon, and a Cosmetic Breast Augmentation Specialist.
Based off your photos you have have breast sag aka breast ptosis in addition to some tuberous.  Most people would place this under the muscle.  I dont think this will cause a double bubble. .  I would suggest that you see a board certified place surgeon for an in person consultation 
I hope that helps!  Best of Luck!
Matthew J. Nykiel, MD
#CoreAesthetic
Breast Augmentation Specialist
Board Certified Plastic Surgeon

Your breasts are not tuberous but ptotic.  With massive weight loss, augmentation will not solve your problem and you need a breast lift.  The technique I recommend is The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained.  At the same time or later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices and half are removed by 9.5 years.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

Looking at your photos I am not certain that you have tuberous breast deformity, or if you do it is very mild.Although it is difficult to tell by photos, I would say that you would be a good candidate for breast augmentation with a lift.  The type of lift you would need would likely be a full/anchor lift but again and exam can help determine exactly what you would need.Implants placed behind the muscle is pretty much standard these days given all the issue that can happen when the implants are placed in front of the muscle.  When we say behind the muscle what we are really saying is that it is placed in a dual plane (lower part is behind the breast tissue and upper 2/3 is behind the muscle.Hope that helps.

Dear SunshineBaby904,I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Tuberous breasts are not simply small or underdeveloped breasts. The appearance of the breast can range from mild to severe, and typical traits include: enlarged, puffy areola, rather wide spacing between the breasts, very little breast tissue, sagging, higher than normal inferior breast fold, and narrow base at the chest wall.The type of surgery best for you will depend on the severity of your condition.My preferred technique for tuberous breast correction involves a multistep procedure where the breast tissue is released in a radial pattern to prevent herniation into the areola and placement of a custom implant size is in the breast to allow appropriate expansion of the breast in the restricted dimensions. This can often be done in a single procedure but sometimes may require two surgeries.That said, it is best that you visit a board-certified plastic surgeon for an in person examination. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for your photos and questions.  Based off your photos you should be able to have subglandular implants, granted an inperson exam will tell for sure.  I would also recommend an areolar reduction and breast lift to match a perkier, fuller breast. Best Wishes!Dr Jamie Moenster, DO, FACOS, FACS

Thanks so much for your question.  I do not think you have a true case of tubular breast deformity.  I think you can either place the implants in a sub glandular pocket and with no lift but you would still have some droop to your breasts.  Otherwise if you want a perkier look, you could place them in a submuscular pocket and perform a mastopexy (lift).  

If you do not have a lift, you would be at significant risk for a double bubble. You might be able to get away with it subglandular, but I would think you would better serve your long-term happiness with the combined procedure.  Congrats on the weight loss.  Good luck!