How can I correct my double bubble?

I would love some expert advise on how to fix this double bubble I have been experiencing ever since I had my surgery in April of 2012. I am 9 months Post op, 36 years old, and 149 lbs, 5'6". I have 425 cc moderate plus mentor gel implants.   My incision is below my natural breast crease, which seems to make this an especially complicated case. I initially had wanted 325 cc implants, so I am also unhappy with the size and would like to have this corrected when I fix the double bubble. My doctor recommended I fix the problem with a crescent or doughnut lift. I feel like this would look very awkward.   I would appreciate any advice or feedback! Thank you!

Doctor Answers 12

Double bubble deformity

If you are unhappy with your actual size, changing the actual implant with a smaller one and fixing the pocket (suturing the pocket at this level) can improve that double bubble. Another good option is to use fat grafting to disguise the shadow. The fat overfills this area and you should not need any surgery inside.

Spain Plastic Surgeon
3.0 out of 5 stars 3 reviews

How to Correct the "Double Bubble" after breast augmentation

The line that you are seeing is where your breast fold USED to be-- it is created by 2 things, tight skin as well as attachments between the muscle and the skin (and of course, placing an implant underneath). There are two ways to fix this problem: one would be to convert the implants to over the muscle. By doing this, the attachments between the muscle and the skin are divided and this line should fade. However, depending on the amount of native breast tissue you have, this might not be a good idea. An alternative plan would be to just go in and surgically divide those attachments (ie, make the surgical plane as if you were going to transfer the implants to a subglandular pocket, but leave them under the muscle. I've seen this a lot, and this is pretty easy to fix. Good luck.

Matthew Concannon, MD
Columbia Plastic Surgeon
4.6 out of 5 stars 21 reviews

How can I correct my double bubble?

I am sorry to hear about your concerns after breast augmentation surgery. One of the most common complications after breast augmentation surgery is implant malposition. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).

It looks like you might have double bubble after your revisionary 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. Sometimes, in situations like yours, the appearance of the breast improves over the course of the first several months; sometimes, additional surgery may be necessary to improve the outcome.
This is corrected by “raising” the inframammary fold using internal sutures (capsulorraphy). I have also found the use of acellular dermal matrix very helpful in cases where the skin/tissues are very thin.

I hope this, and the attached link, helps.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Double bubble post augmentation

The issue of a double bubble is due to the pocket extending below the actual fold in your breast.  To address this I would perform a neo-subpectoral pocket.  I am assuming your implant is under the muscle.  This would involve creating a new pocket under the muscle but, in front of the capsule of the old pocket, closing off the old pocket so that the implant cannot get back into that space and reattaching the fold in its normal position.  If you want to down size this is a good time to do it as the new pocket can be made narrower to accommodate a smaller implant which would also make this easier to achieve your desired result.

Roger J. Friedman, MD
Bethesda Plastic Surgeon
5.0 out of 5 stars 8 reviews

Double Bubble

Thank you for your questions. This is a condition where the implant and the native breast are in completely different anatomical levels. Routine subpectoral mammary augmentation in women with a small breast lower pole deficiency often results in poor late results with the appearance of a double-bubble deformity. The surgical correction is complex and requires the need for a series of a. excision of breast tissue, b. pocket adjustment or capsulorrhaphy and c. exchange of implants or any combination of the above. Best of luck!

Dhaval M. Patel 
Double board certified 
Plastic surgeon
Hoffman Estates

Dhaval M. Patel, MD
Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 93 reviews

Double bubble

The line that you see is your old inframammary crease. I would convert these implants to a subglandular pocket and reconstuct the crease again

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 14 reviews

Double Bubble Issue.

First, I do not think a crescent lift will address the issue.  Double bubbles occur in women who have a tight fold prior to implant surgery and during implant surgery the position of the fold is lowered.  The original distinct fold is still present.  A couple of options, to keep the current implant size and try to soften the old fold internally. Second option would be to downside the implant and reset the old fold internally and or the use of a scaffold such as STRATTICE.

Dr. ES

Correcting double-bubble deformity

It is not possible to be sure from the single photo but true double-bubble deformity (in my opinion and experience) is not the conventional "wisdom" of the old inframammary crease. It is caused by slippage or stretch of the planned or appropriate inframammary crease level (with a properly sized and positioned implant) and/or the free edge of the pectoralis muscle released from the chest wall but not from the underside of the breast tissue or fascia (connective tissue) in the lower pole. If the pectoralis muscle is released adequately in a dual plane and the inframammary crease level is controlled, this should not happen. 

Correction involves proper diagnosis of the cause, but a crescent or donut lift will not help it. I would add that one cannot just choose an implant size and expect it to fit and look right, but changing the agreed upon size of the implant during the surgery suggests a problem in fitting the implant properly which could have affected the inframammary crease level. Unfortunately breast implants cannot be scaled down in width/height easily but the forward profile can be reduced and the tissues will accommodate it. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Double Bubble After Breast Augmentation

Great question and thanks for asking!  Without more pictures from different angles it is difficult to answer your question with any certainty, but I encourage you to seek an opinion from a Board Certified Plastic Surgeon to get an accurate diagnosis and surgical plan.  Typically when this problem occurs, it is corrected in the operating room by repairing the original fold in it's natural position using internal sutures.  External mastopexy approaches are not going to help alleviate the issue if the fold is riding high on the breast.  Best wishes!

Brian Howard, MD (retired)
Alpharetta Plastic Surgeon
4.3 out of 5 stars 19 reviews

Double bubble

A double bubble is created when a doctor tries to lower the fold under the breast or the implant slides downward because the fold has been weakened and can't support the implant adequately.  If this has not resolved in nine months then it probably will not resolve on its own.  A crescent or donut lift will elevate your nipple/areola but will do nothing to correct the double bubble.  Changing implants and going with a smaller volume implant will not correct the double bubble.  The only way to correct this, in my opinion, would be to reconstruct your fold back to its original position using stitches inside the breast pocket.  If this makes your nipple/areola sit too low then a smaller implant or a crescent/donut lift may help.  Restoring the original fold is the first order of business, however.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 25 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.