Will fat grafting fix my double bubble deformity? (Photos)

Question

I am 7 months post-op for my breast augmentation. I have 520cc submuscular. I was a 34B prior to surgery. I have this "double bubble" issue a lot in the left breast and very minor in the right breast. I have expressed my concerns with my surgeon and he is proposing doing a fat graft (from my stomach) to fill in the crease in the left breast. I'm concerned about this because I have read several things about this not working and that I should be having revision surgery to get this fixed.

Donald R. Revis Jr, MD · Answer

Good afternoon!No- it doesn't work- period. It is an attempt to camouflage the problem rather than address it directly and fix it. I repair it by performing a capsulotomy on the inside to release the Double Bubble, and the Internal Bra, my strong permanent internal suturing technique, which corrects the problem.

Daniel Barrett, MD · Answer

Dear Heather2121,though rare, some women who undergo breast augmentation will develop a minor deformity known as a “double bubble,” in which additional folds appear underneath the breasts due to the implant accidentally shifting or contracting post-surgery. In most cases, the implant simply slipped too far down the chest wall and traveled behind the breast inframammary crease (the area where the lower breast meets the chest), instead of moving forward to fill the breast cavity. If left untreated, the lopsided implant will form unnatural indentations, resulting in an odd “four-breast effect” rather than the full, rounded chest the patient initially desired. In most cases, pocket revision is required in order to address the issue. Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Gregory T. Lynam, MD · Answer

When the distance from the nipple to fold is too short to accommodate an implant the fold is releases to create a longer distance to accommodate the bigger implant. Plastic surgeons do this every day. The problem occurs most frequently in larger implants since they are heavier and often migrate too low over time. The release of the old fold crease and muscle must be done well and even then it often shows but gets better over time. If it was just a   visible skin depression and proper implant position then fat grafting would be a reasonable option. In your case revision with smaller implants plus tissue graft if needed is best idea. Good Luck and update us please.

Gary M. Horndeski, MD · Answer

Fat grafting won't FIX it, it will simply hide the problem temporarily. The problem is that the chest muscle was cut to accommodate the implant at a lower position to avoid a waterfall deformity. Now that the chest muscle has been compromised, the implant will continue to migrate down the chest making things worse for you. Simply placing the implants on top of the muscle will also be a temporary fix. 520cc implants are too heavy to be supported by skin alone. They too will eventually stretch your skin and will require a lift. At 520cc you are also at high risk of developing a capsular contracture.  Please consider downsizing to minimize complications down the line and find someone who will re establish your natural IMF by supporting sutures or using a supporting structure. I hope this helps.Best wishes,

Michael Orseck, MD · Answer

without getting into surgical specifics, I do not think that fat grafting is the correct treatment for this. I would seek another opinion to discuss more standard surgical options for the correction.

Tom J. Pousti, MD · Answer

I would share your concerns; I do not think that fat grafting is the best solution. Instead, skillful adjustment of the breast implant capsules and repositioning of the breast implants will most likely achieve a long-term outcome that you will be pleased with. Sometimes, if "redundant" skin persists  along the lower breast poles, direct excision of the excess skin may be helpful. Best wishes.

Don Fontana, MD · Answer

Interesting idea, but  the problem is not with inadequate breast filler. It is a muscular issue which must be repaired. Graft grafting is wishful thinking IMHO.

Khashayar Mohebali, MD, FACS · Answer

I can see some asymmetry along with the double bubble. I don't believe fat grafting alone is going to solve all your problems.  Fat grafting may be helpful in conjunction with other revisions including possible fold revision and implant exchange.  Also, potentially changing the location and size of the implant will solve the problem as well. Discuss with your surgeon all other revision options before proceeding with fat grafting alone.

Hilton Becker, MD · Answer

Double bubble deformity occurs with submuscular implant placement where the muscle is detached inferiorly ,I correct double bubble deformity by placing the implants above the muscle.I dont believe that fat grafting will correct this problem

Bennett Yang, MD · Answer

Hello and thank you for the question and the photos. The double bubble can be a difficult problem that most of us have faced over the years. There are many reasons someone can develop a double bubble. Your pics show a low and large implant with asymmetry. If these are "selfie" pics, it looks like your right breast is smaller and higher than the left. your PS might have tried to put the implants evenly and thus lowered the right implant to match the left. In doing so, they causes the double bubble which is worse on that side. The after pics show the same issue with the right nipple still higher than the left. It's important to remember that the correction may take more than 1 procedure. It may take 2 or 3. 1. i would suggest removing skin from the bottom of the right breast. It will help "pull" down the right nipple and get rid of the slight excess skin you have below the double bubble. 2. You may want to consider an exchange. I would suggest a larger implant on the right to match the left. Ordinary, this is bad advice, as the larger and heavier implant will sag more and worsen the DB. You could opt to make the left smaller, but it will leave that breast with loose skin and look worse. I would also suggest a light textured implant like the mentor. There is controversy about the using textured implants, as there have been some rare cases of ALCL cancer. It's extremely rare with this type of implant ( 1 in 64,000 ) so you need to be aware of this risk. However, I find textured implants to stay in place better and migrate less than smooth implants. 3. Finally, after the above is done, then consider fat grafting. Fat grafting is very useful, but it's at best a tune up option vs the main benefit. When done alone, it's usually not enough to fix the issue. Best to you. @bennettyangmd

Will fat grafting fix my double bubble deformity? (Photos)

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