What type of breast revision is required? Do I have a double bubble? Seeking a second opinion.

325cc Allergan High Profile dual plane First surgery was August 2014, first complication was the implant in my right breast was too high. Revision was done on my right breast in January 2016, now I have a double bubble. Booked for revision 18 November 2016 of my right breast again. The plastic surgeons have changed their mind from doing a full revision using fury polyurethane implants, as they tell me my double bubble has gone away. All revisions have been covered under warranty.

Doctor Answers 9

Correction of double bubble requires analysis of the cause

The picture shows a double bubble. There are two possible causes: One is that the fold was lowered, which may have happened with the first revision. The second is that it is related to the dual plane placement which often causes traction of the muscle (animation.) You can diagnose this by simply flexing your pectoral muscle and observe if you see pulling up along the double bubble crease. Correction of the problem is different for each of these causes.


Seattle Plastic Surgeon
4.9 out of 5 stars 47 reviews

Breast augmentation - change of fullness

Thank you for your question. If your appearance has changed since you posted this, I apologize for these suggestions. Presumably, the first revision was to lower the right impact to match the position of the left side. So now that you have the inframamary folds in the correct plane, the original line of the right breast is visible.

While the plane in store may work, other options include releasing the original infra-mammy fold on the right side. This can be helped by fat grafting the release. Other surgeons made good suggestions also.


Hope this is your last revision.  

Michael Kulick, MD, DDS
San Francisco Plastic Surgeon
4.1 out of 5 stars 10 reviews

CORRECTION OF DOUBLE BUBBLE

During breast implant surgery a pocket is created carefully to maintain certain folds on the sides and bottom of the breast. On occasion, the space for the breast implant becomes too large on the side of the chest or the tissue stretches and the implants fall too much to the side. This is most easily seen when the patient is lying on her back. On rare occasion, the implants can move towards the patient’s armpit.

Treatment will generally require closing the space with a procedure called a capsulorrhaphy. In this case, the capsule is closed off internally much as we do when we are trying to raise the breast fold. The capsule is closed with sutures and at times Acellular Dermis Matrix (ADM) or other soft tissue substitutes would be used to further support this correction.

I am unaware of these procedures being covered by insurance and polyurethane implants are not fda approved and available in the US at this time

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

Double bubble

By the image you provided your right implant appears to be lower than the natural fold leading to a double bubble. Repair involves re-supporting the fold which can be accomplished by suturing the capsule. 

I hope this helps

Dr Edwards

The Double Bubble Deformity: Options for Corrections

Thank you for your question regarding the appearance of your right breast.  You have a classic double bubble deformity.   These can be frustrating for patients and difficult for doctors to correct unless they are very experienced and understand the causes and correction options for you.   

As you may have learned, the double bubble is caused when the implant falls below your original breast crease and the breast tissue.  You are seeing the bottom of the implant in the lowest-most area of fullness, followed by a crease in your breast which is the original bottom or crease of your breast.  The fullness above the crease is your breast tissue and implant.

Correction is often done by elevating the lowest portion of your breast and creating a higher new crease position.  However, if your implants are even, this crease elevation may create a new type of asymmetry.  A better option may be fat grafting to the right breast fold to hide the double bubble.  I published an article this year in a peer-reviewed plastic surgery journal which outlines the technique for doing this.  It can give great results with only needing local anesthesia.  We have treated over 100 patients with double bubble from many plastic surgery offices with this technique achieving dramatic improvement.    I will attach the link for your reference, and you may wish to forward this to your plastic surgeon to see if they feel it may help you.

Best wishes....Stephen Bresnick MD

Stephen Bresnick, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 31 reviews

No real warranty

There is an implant warranty but not a warranty to fix problems with how the surgery was performed. Your old breast fold is still visible. It may get better over time. Most of the time if the distance from your nipple to the breast fold is short then the fold needs to be lowered. his can be a difficult decision and the old fold may be visible. Techniques to minimize this such as a dual plane are used. Your surgeon is likely paying for your surgeries as there is no warranty to pay for what you are talking about. Good Luck

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 55 reviews

What type of breast revision is required? Do I have a double bubble? Seeking a second opinion

It appears to me from the picture that you may have a DB.  This can happen also when your skin envelope is loose over the implant.  See if the appears improves with tightening the skin around the areola. I would think it would.  What you are seeing is a separation point between your old crease and your new crease. Your new crease has no breast tissue so it appears thinner than the area above it.  A skin tightening procedure may reduce this appearance and save you from needing a larger procedure done.  Good luck!

What type of breast revision is required? Do I have a double bubble? Seeking a second opinion

I am sorry to hear about your concerns after breast augmentation surgery. 


It looks like you have "double bubble"  after breast surgery. 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.   Double bubble "deformities" may be more striking (visible) when breast implants have bottomed out.


 

There are several options when it comes to revisionary surgery to improve your outcome.  One option is to eliminate the pull of the pectorals major muscle either by completely releasing it or by suturing the muscle back down, thereby placing the breast implants  in the sub glandular position.  Patients who choose to have breast implants placed in the sub  glandular position should have enough breast tissue coverage to allow for this conversion. There are disadvantages of placing breast implants in the sub glandular position (such as increased risk of breast implant encapsulation) which should be considered as you make your decisions.



Another maneuver that may be helpful is raising the inframammary fold using capsulorraphy techniques. Sometimes, depending on factors such as quality of skin along the lower breast poles, additional support provided by acellular dermal matrix or biosynthetic mesh may be very helpful. I have also found the use of acellular dermal matrix very helpful in cases where the skin/tissues are very thin and in cases of recurrent breast implant displacement. The acellular dermal matrix helps improve contour, improves irregularities caused by the underlying breast implant and/or scar tissue, and provides additional support ("sling" effect) for the breast implants.

 


Make sure that your selected plastic surgery can demonstrate significant experience with revisionary breast surgery, achieving the types of outcomes that you will be pleased with. You may find the attached link, dedicated to revisionary breast surgery concerns, helpful to you as you learn more. Best wishes.

 

Inferior malposition

Thanks for the question and I'm sorry you've been having so many issues. Looking at the single photo you provided, it looks like you have an inferior malposition of your implant. What that means is that your implant has started to migrate down onto your chest wall below where your original incision was. In order to fix this a new pocket will need to be made and secured to make sure your implant doesn't move again. 

Seeing you in person may reveal that there is something else going on. For your revision you need to make sure you see a plastic surgeon with a lot of experience in revision breast surgery. Best of luck!

~Dr. Sieber

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.