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

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.

 
 

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.