Bigger implants/fixing double bubble; what should I do?
I am sorry to hear about your concerns after breast augmentation surgery.
It looks like you have "double bubble" and breast implant bottoming appearance after your revisionary surgery. A "double bubble" is a cosmetically undesirable circumstance for patients with breast implants, which occurs when the breast fails to take on the shape of the implant, resulting in the appearance of a visible line showing a separation between the bottom edge of the implant and the bottom edge of the natural breast. Double bubble "deformities" may be more striking (visible) when breast implants have bottomed out.
There are several options when it comes to revisionary surgery to improve your outcome. One option is to eliminate the pull of the pectorals major muscle either by completely releasing it or by suturing the muscle back down, thereby placing the breast implants in the sub glandular position. Patients who choose to have breast implants placed in the sub glandular position should have enough breast tissue coverage to allow for this conversion. There are disadvantages of placing breast implants in the sub glandular position (such as increased risk of breast implant encapsulation) which should be considered as you make your decisions.
Another maneuver that may be helpful is raising the inframammary fold using capsulorraphy techniques. In my practice, this type of repair involves a two layer, permanent suture repair (reconstructing the inframammary fold areas). This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation.
Sometimes, depending on factors such as quality of skin along the lower breast poles, additional support provided by acellular dermal matrix or biosynthetic mesh may be very helpful. I have also found the use of acellular dermal matrix very helpful in cases where the skin/tissues are very thin and in cases of recurrent breast implant displacement. The acellular dermal matrix helps improve contour, improves irregularities caused by the underlying breast implant and/or scar tissue, and provides additional support ("sling" effect) for the breast implants.
In my practice, I have found that the use of larger breast implants is most often possible.
I hope this, and the attached link, helps.
Fixing double bubble troubles requires analysis
Double bubble can be caused by two things: A high fold (short distance from nipple to fold) requiring expansion of the pocket below the pre-existing fold, and/or release of the pectoral muscle as in the dual plane procedure. In this instance, the edge of the released muscle heals onto the capsule and pulls, creating a groove across the lower breast like the one in your picture. You appear to be in the former category but if you see pulling up at the crease when you flex your pec then that will have to be corrected also. That could be done by switching to the split muscle plane. Bigger implants should be considered ONLY if the diameter of the implants is not increased.
From the appearance of your preoperative breast, it appears to me that some attempt has been made to lower the crease to accommodate a larger implant. This can cause both the problems of bottoming out as well as a double bubble. In order to fix the pocket and decrease the size of the areola, some skin of the base of the breast in the chest wall needs to be returned to the breast and some skin around the areola where the pigmented skin is, needs to be removed as well. It may be difficult, with the necessity of taking out some skin to accommodate a larger size implant which may put an undue stress on these new repairs. You might want to consider adding an adm such as Strattice to help support the bottom of the breast. Good luck with your revision.
Redo breasts augmentation
DearAmanda, Thanks for submitting your before and after pictures and sorry for your problems. From observing your before picture, you appear to be small A cup size with large areolas and the right nipple is hanging over the right lower pole. The after pictures reveal the followings: 1. Right breast double bubble. There was a hint of it in the before picture. 2.Wide cleavage. 3. Lateral displacement of left breast implant. 4. Large areolas. 5. Small C cup size. You did not provide your chest circumference measurement in inches which is critical for selecting the correct implants size. Lets assume that you are 32 small C cup size currently. To become 32 full C cup size, you will need implants with volume of 375/400 cc . For 32 small D cup 400/425 cc. To correct your problems you will need the followings: 1. Bilateral inferior capsulorrhaphy (internal bra ), to correct the double bubble on the right side, raise the folds and breasts and create symmetrical folds.Raising the right fold only will create asymmetry.
2. Medial capsulotomy(scar release) and left lateral capsulorrhaphy , to achieve nice cleavage. Most predictable result is through sub areola incision, which allows for precise dissection under direct vision and feel. The sub mammary fold incision is too far. 3. Bilateral areola reduction with moderate mini lift (donut, Benelli), because the folds lift will ptosis. 4. Possibly superior capsulotomy, if you have superior capsule contracture, which can be assessed on physical exam. This is a complex revision, so make sure that your surgeon is an experience board certified plastic surgeon who has lots of experience with redo breasts augmentation. Check the before and after pictures in the photo gallery, to ascertain that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking. Best of luck, Dr Widder
Your issue looks like in the photos that your folds might have been lowered. You are probably better off with smaller implants or same size and correction of your fold. Going larger in a tight pocket may cause the same thing to happen all over again.
Can be a difficult solution- revising the capsule with possible mesh may be indicated. Larger implants can easily be added.
An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations.
It appears from your photo that you need breast pocket revision. The pocket appears to be too low, and that is why your nipple is so high. An exam is needed to determine if you have week tissue and would benefit from Strattice for reinforcement. Not sure I would go with larger implants, but once again that would be determined at an in person exam. Consult with your Plastic Surgeon to discuss all your options.