How can I correct my 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.

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 surgeonHoffman EstatesBarringtonOakbrookChicago

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

    A smaller implant can always be placed.  With regard to a lift and the present scar placement, any further advice is hard to provide with the single photo.  If you post a frontal view with the camera angle at the level of the breasts as well as profile views, better advice can be offered.

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.

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

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.

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.

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.

Double Bubble
There are a number of conditions that are collectively called "double bubble." As the term implies, there are two contours visible, where only one is desired. I think of three separate conditions:
•Patient needing a lift who did not have one, resulting in the native breast tissue sagging off the breast implant, creating two contours.
•Lower margin of the pectoralis muscle creating an impression on the implant causing two contours
•The original breast fold causing an impression on than implant which is positioned lower than the fold.

Each has a separate cause and separate treatment. I don't think the issue here is failure to do a lift, but rather one of the other causes.

I can't tell too much from this photo of just one breast with the arm elevated, and without preop photos. A front and side view of the breasts with the arms at the side would be helpful 

When the time comes for correction a small implant will simplify the issues present. 

Thank you for your question and for the attached photo. Best wishes.