Could I Be Bottoming out or Have "Double Bubble?"

I just recently heard these terms, but I'm afraid this may be my situation. I had surgery in August and I've only been able to follow up once or twice due to my doctor being 2 1/2 hours away. I'm not sure how to describe it, but it looks like my real breast is still there, and that the implant is dropped below it... it is also lumpy and I can see the disfiguration of the implant through my skin. I had the surgery to fix extreme asymmetry, so I'm very frustrated.

Doctor Answers 10

Double Bubble

Dear Concerned,

Unfortunately, your implant is sitting below your natural inframammary crease, in a less than satisfactory position.  This is known as bottoming out.  In addition, there is the curve of your breast gland above the crease, and a separate visible curve of the implant below the crease.  This is known as a double bubble.

These two problems frequently occur together, and occur most often in women with high inframammary creases and/or widely spaced breasts.  This situation is exacerbated by implants that are physically too large for the women's anatomy.  I believe this describes your situation accurately.

You will need to see a surgeon that specializes in revision breast surgery, and who is certified by the American Board of Plastic Surgery.  The surgeon needs to remove your current implants, close down the lower portion of your implant pockets, possibly place dermal matrix implants near the bottom of your breast implant pockets, and then replace with smaller breast implants.  This is the only way to get a normal contour to the lower pole of your breast again.  You will have to sacrifice size, at least for now.  After at least a year, after your breast skin and tissue has expanded, you may elect to remove and replace with larger implants.

I wish the best of luck to you, I'm certain you can get a result that you will be happy with!

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 90 reviews

Bottoming out and double bubble troubles

The picture shows both a double bubble and bottoming out. The double bubble is the groove across the breast where the original bottom edge was (inframammary fold). Since the implant is a larger diameter than the breast, it pushes below this fold in order to be centered in the breast. When there is not enough support, the implant drops even more which is bottoming out. The picture also appears to show a pucker of the implant, also relat4ed to too large a diameter. Correction of this type of compound problem requires special expertise so you will need to be very comfortable with your surgeon's explanation of the problem and plan for correction. One important thing to observe is if there is pulling upward at the level of the groove across the breast when you flex your pectoral muscle; this is called an animation deformity and adds yet another level of complexity. There are some examples on my website of how to correct these problems.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 53 reviews

Bottoming out

From what I see in the photograph it appears that what you have is called "bottoming out". This happens when the implant slides behind the Scarpa's fascia, which is very importantly attached to the chest wall as the inframammary fold. Sometimes, when we try to expand the base footprint of a small breast, these attachments become quite thin, and with time and implant pressure, can give way and allow the implant to slide downward. Reconstruction of the fold will likely be necessary, and the old fold and lower pole of your breast could need to be scored to allow it to expand over the implant. A smaller implant may be needed as well. I know it's far, but you need to see the doctor and ask for enough time for the two of you to really discuss the options.

Verne Weisberg, MD
Portland Plastic Surgeon
4.5 out of 5 stars 17 reviews

See Your Doctor About the Bottoming Out of Breast Implants

"Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.

Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant.
This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold. However, it is best to consult with your Plastic Surgeon to better confirm with an in-person exam.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 110 reviews

Bottoming out of breast implants and double bubble

Based on your photos shown you have both issues here which will require surgical correction to recreate the natural inframammary fold and possibly replace your implant with a smaller one.  In some cases, a synthetic skin substitute (acellular dermal matrix) is needed to to reinforce the lower aspect of the breast pocket.

There are many fine board certified plastic surgeons in the Atlanta area who can help you correct this issue.

Best wishes,


William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 375 reviews

Double bubble after breast augmentation

It appears to be a double bubble with the implant now positioned below the fold.  It will need surgical correction. Hang in there and keep your surgeon posted.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

Breast Implant Position Problem

Yes, unfortunately your implant is lower than where it should be. According to your photo, the implant is resting below the inframammary fold which defines the normal lower margin of your breast. There is no effective treatment other than a revision to correct the problem appropriately. I recommend contacting your plastic surgeon.

Derek Lou, MD
Houston Plastic Surgeon
5.0 out of 5 stars 8 reviews

Double bubble

Yes your photos do show that the implant has dropped below the inframammary fold and resulted in the appearance you have.  You should call your PS and sent your photos. You should be prepared for a revision.

Delio Ortegon, MD
San Antonio Plastic Surgeon
4.1 out of 5 stars 26 reviews

Bottomed out with a double bubble

Unfortunately you have both problems and will need a revision.  Send these photos to your surgeon but also there are fantastic breast surgeons right there in Atlanta.  Good luck!

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Double bubble

From the photos you posted, you seem to have a double bubble which is a form of bottoming out. The fold needs to be resuspended and you  may need to have a smaller implant.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.