Double bubble, 400c, medium high profile 5 months ago, can this be corrected? (Photos)

Question

I got 400cc medium high profile implants in Nov of last year. The surgeon is very well known and experienced. He told me the morning of the procedure that he needs to lower my crease. Got double bubble from the first day after surgery on. He told me to put tape under the boobs and wear the surgical bra, but the double bubble stayed the same. He said it was because of the pre boob job situation - but i shouldn't he have known/told me before? he said revision would be very difficult.

Gary M. Horndeski, MD · Answer

In your before photograph, your breasts were low on the chest wall, quite lateral and you had poor cleavage. Your physician placed the implants underneath the nipple-areola complex resulting in inferior and lateral displacement of your implants. At this time, you will need to have circumareola approach as well as an inframammary approach to raise the nipple-areola complex higher and more medial and to reinforce the capsules of the implants inferior and lateral to push them up and in.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Humorous634174,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.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

Actually, the inferior pockets need to be positioned back where they were. Mesh might be needed. Please do not go larger.

Mats Hagstrom, MD (license on probation) · Answer

During my residency, I spent some time working with the now retired world, famous Rollin Daniel MD who contributed significantly to rhinoplasty surgery.
Dr. Daniel had no shortage of ego or attitude.
Despite his abrasive personality, he did have a few things to teach.
One of those was to never mess with natural creases on the body. He used to day “only God can make creases”
This includes the IMF, a.k.a. infra mammary fold.
The fold should not be opened.
You have small diameter breast, than that should limit the size of implants used during surgery.
Opening the IMF created the situation you now have.
Once the fold has been opened, it’s very difficult to put it back in place.
Opening the fold puts you at risk for having implants that bottom out in the future. 
 Famous in regards to plastic surgery does not equal talent.
If anything famous is probably inversely correlated to being talented.
The outcome of your procedure is a direct reflection of your candidacy for the procedure, and how the operation was performed.
There are generally three variables that determine breast augmentation outcomes.
The first is patient candidacy. The second is implant selection in regards to size shape and type and the third is the surgeons ability to place the implant in the correct anatomic location.
The implants used are substantially larger than your natural breast diameter.
Your breast also sit wide on your chest wall.
In your case, all three variables are contributing to your outcome.
In other words, your candidacy, the selection of implants and how the surgery was done are all contributing to your outcome.
There isn’t much patients can do regarding their own candidacy, but understanding your candidacy and inherent limitations can help people accept the type of outcomes that are possible, and this can increase overall patient satisfaction.
 If patients are not ideal candidates, then they should be told this well in advanced during your in person preoperative consultation.
Your situation is now fairly complex and successful revision surgery is going to be difficult.
You need to find somebody who has sufficient experience to try to improve the outcome.
Considering the outcome and surgical decisions of your first provider I don’t think that is the surgeon to do your revision.
To find the right provider, I generally suggest patients have multiple in person, consultations with providers in their community.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who had a very similar characteristics to your own. 
It may be difficult to find surgeons who can show you previous cases having corrected the exact same outcome as your own but it is in many ways, the same procedure as correcting implants that have bottomed out.
The fold needs to be reestablished, and re-enforced generally using permanent sutures with or without mesh or cadaver dermal products.
Best,
Mats Hagstrom, MD

Double bubble, 400c, medium high profile 5 months ago, can this be corrected? (Photos)

Answers (4)

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