I have a slight double bubble what can I do to ensure it doesn't get worse? (Photos)

Thank you for your question.
At 4-5 months the pockets around the implants are starting to stabilize and hopefully the implants will not drop further.  A double bubble appearance has several possible causes.  
First is the implant dropping too low relative to the breast tissue and the natural IMF.  In your case the current IMF position is just below the incision.  If the incision placement was at the desired IMF as planned by your surgeon, then there has been some downwards shift of the implant over time. If your incision was planned above the IMF where it currently sits, then the implants are likely in a stable position overall.
Second is a constricted base to your natural breast tissue and in particular the lower pole.  Some patients are very short from the nipple to the original IMF (4-5 cm) and larger implants that are wider than the base of the natural breast tissue can lead to a transition from the curve of the lower pole breast tissue to the curve of the (wider) implant.  This happens more commonly when your natural breast tissue is very dense and will not spread out softly over the implant or when an implant is chosen that exceeds the base diameter of the breast (too wide or big an implant).  The firm breast tissue in effect sits like a hockey puck on the larger breast implant (sorry for not having a better description for that).  
Surgeons sometimes approach this with shaped textured implants to force more expansion of the lower pole, or "scoring" the lower pole breast tissue to weaken it so that it is more likely to stretch.  A natural result for a 425 cc implant might need 8-12 cm of final distance from the nipple to the fold depending on how large your breasts were to start with.  You can recruit 1-2 cm from the skin below the fold during the surgery but ultimately the rest has to "stretch" as the implants settle to reach the ideal final length.   Controlling the degree of stretch can be difficult as it depends on your natural healing and scar formation (genetics), activity level, use of supportive garments as well as the degree of release or support the surgeon creates during the surgery.
The third cause is dynamic and relates to the natural breast tissue sliding up and lateral when you lift your arms or contract the pectorals muscle.  The breast is attached to the muscle (assuming the implants are below the muscle) and when the fibres of the muscle are pulled up or contracting, the breast slides with them.  That may be a component of what you are seeing when you lift your arms as well.
In the end it is best to see your original surgeon and discuss your concerns.  Regular checkups in the first few months allow us to work with you to optimize activity level and bra use to try to get the final shape as close to ideal as possible.

Thank you very much for your question
and photographs. From your pictures, it does appear that you are beginning to
see a slight ‘double bubble’. This is in reference to the ability to see the
bottom curve and fullness of the implant, below the curvature of the breast. Unfortunately,
there is no way to prevent the ‘double bubble’ from progressing, however it is
possible that the situation will not get any worse. I recommend that you make
an appointment with your operating surgeon right away, as it is important to
have this situation assessed in-person. Your board-certified surgeon can make
an accurate diagnosis and provide the best recommendation moving forward, which
at some point, may include a breast augmentation revision.

Thank you for your question.
You do have a slight "double bubble". This may not get worse. Massage may or may not be helpful. Please discuss this with your operative surgeon. Please follow his advise and keep an eye on it.  All The Best !

Post operative prevention of a double bubble deformity is difficult. Wearing a supportive bra, with underwire may help some, but checking in with your operating surgeon would be a good first step.Sometimes it will stay minimal, sometimes it will worsen with time.

Hello,There isn't anything you can do to prevent it from getting worse, but there is also NO REASON to massage your breasts. This is an old, difficult to kill, recommendation that has no evidence as being effective at preventing or treating capsular contracture, nor as being necessary for normal healing. IF your double bubble gets worse, you'll need a revision with smaller implants; those were just too big for your anatomy. Best of luck!

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Your implants may be bottoming out.  I would advise not continuing massage and wearing a well supported sports bra.   I recommend
that you seek consultation with your surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

There are a couple reasons for why this would be. You will need to discuss this with your surgeon, as that person will know the details of your procedure. Massaging aggressively may not be the answer, as this could cause your implants to be too low. It may be that additional time will allow this to improve. Remember, your surgeon's advice is the only advice you should follow relatively early after surgery.

Please make an appointment to see your operative surgeon as soon as possible. Implant malposition can progress over time, and is best addressed early. I would recommend wearing good bra support in the interim. Your plastic surgeon will want to know about your concerns.

Thanks for yours photos and questions. A well fitting bra will help. The implant does seem rather large though and unless the inframammary fold is reinforced with either your tissue or an artificial one the bubble will increase. Massage won’t help either. You have overlying muscle providing sufficient massage. Hope this helps. 

Hello. Thank you for your inquiry and congratulations on your surgery!
It is important to have an in-person medical assessment regarding this issue as it is difficult to determine virtually. Continue to update your doctor in the matter and follow their post-op protocol.
It is important to get cleared by your doctor before engaging in specific physical activity before the 3 month healing period has ended as the healing stage is crucial for healthy results.
It generally takes around 6 months to a year to see your final results. Your tissues will take time to relax and allow your implants to "Drop and Fluff" settling into place. Should a revision cross your mind, it is best to wait at least 6 months to a year before doing so.
Our tips for recovery following breast augmentation are to wear a supportive sports bra for 3 months post-operative and refrain from lifting anything heavier than 10 lbs for 3 weeks as we don't want any strain at your incision sites. Make sure to keep the area of your stitches clean by cleansing with hydrogen peroxide daily. Showering is encouraged! But, no sitting in water for 2 weeks following surgery (no baths, hot tubs, pools etc.).
Please note that this response does not substitute patient-doctor relationship. We welcome any and all patients seeking advice to come in for a complimentary consultation available for limited time only.
During the COVID-19, we are offering complimentary online consultations as well as in-office consultation with social distancing and masks. Procedure done in-hospital private surgical facility while taking covid-19 precautions. We utilize UV-light to clean the air of viruses and bacteria during our consultations and surgery. We invite you to come in to discuss your options more thoroughly. Please send us an email at info@drkaraplasticsurgery.com with the subject line: "Attention Meagan" and we will be happy to coordinate your appointment!
M.Kara,MD,FRCSC (27+ years experience) - Specializing in 24 hour recovery/ out to dinner breast augmentation in-hospital private surgical facility for your added safety and peace of mind