Suture technique to fix double bubble: how reliable is it? Should I reduce my implant size to make sure it will work? (Photos)

Question

I have 700cc implants that were placed 2 months ago. I developed double bubble, and my doctor just told me today that it happened because my breast tissue was not strong enough to hold such large implants. He wants revise my pockets using a suture technique. But how reliable is this technique and what is the probability the double bubble will form again? Would it help if I reduce my implant size for, let's say, 600cc instead? I love my 700cc size but I am very afraid double bubble can come back!

Gary M. Horndeski, MD · Answer

Your
breasts are too large and too low for your chest.  I recommend explantation using The Bellesoma
Method.  Your implants are removed, your
breast tissue is reshaped creating upper pole fullness, elevated 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, if not injured during your
previous surgery.  This will eliminate
the double bubble.    Best Wishes,Gary Horndeski, M.D.

Mathew A. Plant, MD, FRCSC · Answer

Based on the photos it looks like you have bottomed out but I do not see a true double bubble. The efficacy of suture capsulorrhaphy depends on the surgeon to be honest. It can be reliable in some people's hands and not in others. If you want to be certain that it will not drop again then you may want to consider having an internal bra procedure performed using alloderm or gala flex mesh. If you are not 100% convinced in your own surgeon's plan then I would suggest having an in-person consultation by a local breast implant revision expert to be properly assessed. Hope that helps!

Shlomo Widder, MD · Answer

Hello again Zumba lover,   Thanks for posting your pictures and sorry for your problem. From observing your pictures, your breasts implants  have bottomed out. I do not see double bubble deformity, however the corrective maneuver is the same - inferior capsulorrhaphy (internal bra).   There is the possibility that you have superior capsule contracture and most likely, you will need superior capsulotme (scar release) , to allow the implants to move upward and reduce the pressure on the new crease.   There are different techniques for capsulorrhaphy, as you can read about in the doctors responses. My technique involves excision of a scar  sleeve from the capsule at the crease and suturing the edges of the wound with multiple interrupted strong permanent sutures, which allow for new capsule to form at the higher position. My patients are instructed to wear bra with wire for 3 months.     As far as your implants size, you can keep your 700 cc size as long as you follow the above mentioned steps.   Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.                Best of luck,                                  Dr Widder

Khashayar Mohebali, MD, FACS · Answer

Based on your pictures, it appears that you don't have a double bubble but the implants have bottomed out.  This can happen when your tissue can not support the weight of the implants. In my practice, I revise and re-enforce with Galaflex as an internal bra.  Has worked well especially with such large implants as what you have in place.  Good luck.

Jason Pozner, MD · Answer

I would add Galaflex mesh to fix the folds. Your tissue may not support the large implants with just sutures but with added mesh should not be an issue

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast augmentation surgery. One of the most common complications after breast augmentation surgery is implant malposition. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).
 
 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.

This is corrected by “raising” the inframammary fold using internal sutures (capsulorraphy). I have found the most success utilizing a two layer permanent suture "repair". I have also found the use of acellular dermal matrix very helpful in cases where the skin/tissues are very thin (or in cases of recurrence of breast implant displacement).

Although I understand the logic of downsizing implants with this type of surgery, I find that it is often possible maintain size, assuming a well executed capsulorraphy procedure.  In my hands, this is best done utilizing a two layer permanent suture repair. The size of breast implants is then determined based on careful preop communication of patients' goals,  careful intraoperative measurements, and after the use of temporary intraoperative sizers.   Sometimes maintaining volume or even utilization of a larger breast implant helps to achieve the increased upper pole fullness that many patients desire.

In my opinion, successful revisionary breast surgery is operator and experience dependent.  In my practice,  I have found that we have an approximately 90 percent long-term successful correction of breast implant displacement problems.

In my opinion/experience, careful attention to postoperative activity restriction is one of the keys to success of capsulorraphy surgery.  The idea is to allow for the "repaired" area to gain full strength (and not be dependent on sutures that may break with strenuous activity) prior to resuming full activity.
 
 I hope this helps.

Suture technique to fix double bubble: how reliable is it? Should I reduce my implant size to make sure it will work? (Photos)

Answers (6)

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