Whats the difference between double bubble and bottoming out?

Double bubble is a description of the shape of the lower breast that occurs when there is an indentation in the lower part of the breast where the breast tissue stops and where the implant continues.  This indent is usually secondary to the preexisting shape of the breast called tuberous or constricted.  The original lower crease of the breast is high therefore there is limited tissue to cover the implant which can result in the double bubble. 



Double bubble is also used to describe bottoming out because the look can be somewhat similar.  However, with bottoming out, or pseudoptosis, the nipple and areola are high and often are visible above the bra or bathing suit.  The bottoming out is secondary to the implant resting too low from over dissection by the surgeon or a capsule that is simply not strong enough to hold the implant. 

Great question.  A double bubble is always the result of dissecting a pocket for the implant lower than the existing inframammary fold, essentially creating a new inframammary fold.  The old fold remains visible  with the implant bulging out between the old fold and the new fold creating the "bubbles" of bulging implant below and breast tissue above the original fold.  Bottoming out is when there is more volume below the nipple than above the nipple, causing the nipple to point upward.  This is most often seen, again, with overdissection of the implant pocket below the natural limits of the breast in order to fit a larger (and heavier) implant.  It can also happen in the absence of overdissection in those  patients who naturally have a long distance from their nipple to the fold if the implant diameter is not wide enough to provide enough upper pole volume to balance the lower pole.  Using a round implant in these patients may require too wide an implant being used which can result in symmastia (uniboob) and lateral displacement.  These patients are usually best served with a tall, shaped implant that will better fit their anatomy and also resist inferior displacement over time due to their textured surface.  

Both are problems associated with implant malposition where with bottoming out the implant and the fold have lowered too much. A double bubble deformity is associated with capsular contracture and elevation of the implant with skin overdraping it. Both require breast revision specialist to correct. Best of luck 

When breast implants are too low, this is called bottoming out. The result is the nipples appearing too high and the lower pole of the breast being too full. It can happen with the implant staying above the inframammary fold (IMF) due to over stretching of the skin of the lower breasts, usually by an oversized breast implant. It can also happen when the breast implant slips below the IMF. 

When the breast implants slips below the IMF and the original indentation from the original IMF is still seen on the lower breast it is called a double bubble. The two "bubbles" are the folds in the breast above the duplicated IMFs. The higher IMF being the original one and the lower IMF due to the breast implant. This is usually only seen with placement of the breast implant behind the muscle.

While not common, both are well recognized problems with breast implants. Both can be addressed with breast augmentation revision surgery. The type of revision will depend on the details of the problem.

Both deformeties are rara and both need surgical correction.  In both situations the implant(s) are lower then the original inframammary fold or are malpostioned. Bottoming out is when the original inframammary fold has been lowered/disrupted allowing the implant to slide below the original inframammbary fold.  Double bubble results from the pressure/indention from the orginal inframammary fold (which stays in the same place) causing the bubble above and below the orginal inframammary fold. Consequences is often auto rotation of the nipple areolar complex rotating upward and thus being located higher than desired and the majority of the volume of the breast lower than desired.

Bottoming out is usually associated with the lack of support or scar in the lower part of the breast implant pocket.  The presence of internal scars on the lower part of the breast can in many cases support the breasts to remain  in an ideal position.  When an individual does not form much internal scar and does not wear good support during the first year after augmentation the implant will sit in a lower position thus creating a bottoming out condition.  Double bubble is commonly seen when a patient is going with a very large implant.  The larger the breast implant chosen the greater the diameter of the implant.  If the current breast is small her current breast fold will be higher.  If the individual wants to go very large then the new breast fold will sit in a much lower position.  It is important for the surgeon to release the bands of tissue that form her old breast fold.  If these bands are not released these bands will remain and she will have two folds, her old fold and the new fold of the larger breast.  This is known as a double bubble.  I see double bubble problems commonly with transaxillary approaches since it is more difficult to release the old breast fold bands when the surgeon is working much further away from where the folds are located.  The periareolar is the easiest to release these bands followed by the inframammary approach. 

Thank you for your question. Both of these issues can be seen after breast augmentation surgery, and have to do with the placement of the implant relative to the breast tissue (in the case of double bubble), and relative to the fold of the breast (in bottoming out). With double bubble, you can see the implant and then you can see the edge of the breast - hence the "double" part of double bubble. With bottoming out, the implant falls below the inframammary fold, and can cause the nipple to rotate up. The second part of your question is more difficult to answer - both issues can occur with implants, but the incidence is hard to say. However, some things can exacerbate the potential of these conditions. One is the size of the implant. With larger implants, you may have the potential to see more bottoming out, because they putting more stress on the tissues, for example. Double bubble tends to occur when the inferior or lower portion of the breast isn't dissected enough, which provides can opportunity for the implant to sit a bit high. If you are thinking about Breast Augmentation, I would suggest having an in person consultation with a Board Certified Plastic Surgeon and asking him or her about the potential for this to occur in his or her hands. This is based a lot on your pre-existing tissues, and your size and shape goals. Best of luck! 

Thank you for your question. "Double bubble" is when you can see a clear demarcation between your breast tissue and the implant. "Bottoming out" is when your implant drop too far past the Inframammary folds. Hope that helps. DrMaz 

Bottoming out occurs then the breast skin extending from the nipple to the inframammary crease becomes stretched out to the point that the implant falls below your nipple, making your nipple point upwards; a double bubble is a crease that develops in the lower breast pole and is typically caused by release of the inframammary crease.

Thank you for the question and you have already gotten some clear explanations.  What I would add is choose your surgeon/expert carefully who should avoid this complicationDr Corbin