Am I bottoming out or Is this double bubble? (photos)

Your heavy implants have sagged some and are bottoming out some. This is why you don't have as much upper pole fullness. I would recommend tightening the lower pocket and going with smaller implants. The lift might need to be tightened as well.

The lift that was performed was inadequate and did not actually lift the breasts up but only your areolas. You also did not need implants at the same time. At this time, your breasts are very low and your volume is largely inferior. The technique I recommend is explantation and lift using The Bellesoma Method. The 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 (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

The double contour you see can be either the original bottom crease (inframammary fold) or related to the insertion of the pectoral muscle into the capsule where it can settle after being cut with the dual plane method. If you see any pulling up of the crease when you contract the muscle then that is the cause. It is called animation deformity. That can be corrected by re-attaching the muscle behind the implant, by converting to either the split muscle plane or subfascial. Three things to know:
1. Re-suturing the capsule may not work because the nipple position is low, and shortening the distance between the bottom and the nipple will look worse.
2. An internal bra is the addition of a layer of supporting material such as Galaflex mesh or Strattice. Sutures are only as strong as the tissue they are sewn into.
3. Consult an expert familiar with revision breast surgery. Your situation has several things going on and one simple solution may not be adequate.