Compound Problems After Breast Augmentation. Advise Please. (photo)

450cc gel implants placed under the muscle 10 weeks ago. Originally, I expressed concern that my left implant was too high, and my PS graciously offered to do a pocket revision @ n/c (haven't scheduled it yet). I'm also noticing a double bubble on my right breast. When I flex my peck muscles I can see a tight band across the implant. I mentioned my concerns about my right breast to my PS he didn't have much to say. What techniques would you plan for my upcoming revision to address both breasts?

Doctor Answers 11

Tuberous breast prop?

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Your left breast is a little higher and that is not unusual early.  I would give that more time, but you may need a release of the capsule on the left.

Your right breast simply does not have enough tissue to cover the implant.  It would not surprise me if you had a tuberous breast preoperatively.  It is subtle and one option is to ignore it. I doubt other persons would ever notice it.  The easiest way to fix that is to place the implants on top of the muscle.  A more difficult method is to use a dermal graft between your breast tissue and your crease.  That would help to camouflage it a little. Good luck.

Breast Asymmetry

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Hello Emily555,

I am sorry that you are having problems after your breast augmentation surgery.  You are 10 weeks out now , and I don't think that 'things might improve' if you wait longer.  I also believe that you are getting close to a time where revision surgery would be appropriate.  A true physical exam would be helpful in determining how much longer to wait.

The underlying problem that caused these very different issues is one in the same: your implants are inappropriately large for your anatomy.  Your surgeon managed to stuff this large and overly projecting implant into the right pocket, but at a cost of lifting your inframammary fold off your chest wall and causing a double bubble. On the left side, the dissection was not as complete, and your body 'pushed back' on the implant, forcing it to move up your chest wall.

The key step to revising your breasts would be to allow the surgeon to put in smaller implants, in addition to any other manuevers necessary to achieve symmetry.   Exactly what those 'other manuevers' are would be based on a thorough physical examination, but might include closing the pocket on the right (capsulorrhapy), and carefully opening the pocket on the left (capsulotomy).

Best of luck.

Double Bubble and High Implant after Breast Augmentation

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Both double bubble and high implant are problems that can occur after breast augmentation. The first is due to not fully releasing the muscle medially. It is one of the reasons that I prefer to place the implants above the muscle if your tissues are such that it is possible. The high implant is due to not dissecting the pocket far enough inferiorly. Both are usually fairly simple to revise.


Robert T. Buchanan, MD
Highlands Plastic Surgeon

Double bubble after submuscular augmentation

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Unfortunately this type of problem occurs when implants are placed under the muscle.  Gel implants are so soft and natural that for almost all women an over the muscle approach is superior.  When the implants are under the muscle the muscle separates the implant from the breast which leads to the double bubble contour. 

Usually this is a late development as the breasts droop with age and the implants stay high, held up by the muscle.  In your case the deformity has appeared early secondary to over-dissection of the pocket under the right implant.

You will need a revision; 3 months is plenty of time for things to mature.  I would release the muscle where it covers the lower half of each implant and reconstruct the fold under the right breast.  Releasing the muscle will allow the implants to flow into the breast space.

Implant issues

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The two breasts were most likely a bit different.  You have to give a bit more time to heal. I would wait 4 months at the minimum.  If there is sitill a lerge discrepancy, perhaps different impalnts can be placed to adjust the volume discrepancy. If you have a double bubble then procedures to adjust that can be done as well.

When to revise breast augmentation

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When the problem is a straight forward one an early revision can stop anxiety and allow you to get on with things. If your issue was with the higher implant only then certainly a release at the fold will bring the implant down. The band across the other breast with muscle flexion, and soft double fold may improve with time, or they might need to be addressed as well. If you can wait several months, you may have a better picture of what the breast will require.

Best of luck,

Breast implant revision

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I usually suggest waiting 3 to 4 months prior to any revision to allow your body to soften and mature the wounds.  From your photos you may require a repair (plication) of the right lower pole with a possible release of the transverse band and/or scoring of the deep underside of the breast gland.  Concomitantly, a release (capsulotomy) of the left inferior pole may also be needed.

Ricardo Izquierdo, MD
Oak Brook Plastic Surgeon

Breast augmentation revision surgery for compound problems

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Of course you understand that no one can advise you without seeing you personally, but here are a few useful things to know: First, I have found that double bubble and animation problems such as you describe are both related to the dual-plane technique for under muscle placement (happy to send you an article if you like.) So fixing the double bubble and the animation problem have a common solution, which is converting to what is called a split muscle plane (see link below.) I would agree based on the pictures that the left implant is too high and a pocket revision is indicated. It could also be converted to the split muscle plane since lowering it may manifest the double bubble/animation that the right one has.

Breast Augmentation Revision Options?

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Thank you for the question and picture.

I'm sorry to hear about the complications you are experiencing.

In regards to the right breast,  internal sutures ( capsulorrhaphy)  will be helpful in reconstructing the right breast implant pocket and correcting the implant malposition.  if I were you I would wait several months at least to allow for maturation of the capsule tissue ( will hold suture better).

Waiting several months prior to revision surgery may also allow the left breast implant to “settle”,  negating the need for revision surgery on the left side.

I would suggest that you make sure your plastic surgeon has significant experience with revision breast surgery;  asked to see examples of previous patients who have had similar revision surgery performed.

Best wishes.

Question about breast augmentation result

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Actually, there might be no problem with the left side at all.  The bottomed out implant needs to be fixed as this will not self-repair and in doing that and tacking the crease back down, it looks like your creases will be even again, the implant will be pushed up to look more like the left one, and the areola will be pulled down to be more level.  Make sure the diagnosis is right as it might all be from the right side even though you thought it started on the left.

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.