4 weeks post op. Double bubble? Swelling? (photos)

Question

Hi, I had Silicone smooth rounds places sub muscular. I did not need or have a lift. Immediately after surgery I was very swollen and my left incision seemed 'higher' than the right. As swelling has gone down, the incision hasn't. My PS saw me yesterday and says we need to wait several months to see if the skin will relax and residual swelling subside. If not and it bothers me, he will do a revision. Does this look like swelling? Or the dreaded double bubble? Other than this they are great!!

Gary Lawton, MD, FACS · Answer

After 6 months this will likely stretch out and look very nice.  At 4 weeks it is too early to tell anything about the results.

Robert J. Schwartz, MD · Answer

I agree with the other surgeons who have responded that 4 weeks out is too early to accurately judge breast implant results.
But there are several things that suggest this will need surgical repair:
The abrupt contour change on the bottom of the breast. That indentation looks like a transition point between breast skin/tissue and chest skin that has been pulled forward and upward. That strongly suggests a double-bubble.The position of your scar. It appears to be the better part of an inch above the crease under your breast  (inframammary fold). This again suggests that your natural crease has pulled away from the chest wall. If you had a well-defined crease before your breast augmentation, that will produce a double-bubble.Your history of scar position asymmetry. This one is a little trickier because I don't know how symmetric your breasts were before your surgery but it does sound like the left implant settled into a lower position than the right.This indentation may improve as you heal but, most often, it will persist. It can be repaired by suturing the fold back into place, by using your own scar capsule to reposition the implant higher, or by placing a mesh support. 
You should wait at least six months from the original surgery before attempting to correct this. Allowing enough time for proper healing will improve the likelihood that your repair is successful.

Alejandro Nogueira, MD · Answer

Still you have chances to smoothen that ugly double bubble effect, I'd give it 90% chances of total correction if the muscle was totally freed from the skin.

Bradley A. Hubbard, MD · Answer

Thanks for your question Shar86. There can be a lot of reasons for the double bubble image shown, including your suspicion about the double bubble. We have all seen results like this improve over the first 3-6 months post-op so it is important for your to be patient. It sounds like your PS is being very appropriate with their care, so stick with them. Best of luck!

Martin Jugenburg, MD · Answer

At 4 weeks post operative it is too early to tell. With time as your surgeon said it will likely resolve on its own as things settle.

Farah Naz Khan, MD · Answer

You are still very early in your healing process so the shape of your breasts will change. I typically advise my patients to wait a good 4-6 months to see their final shape. If, at that point, you still have a double bubble appearance, your operating surgeon can schedule you for a revision. Good luck!

Kamran Khoobehi, MD · Answer

I am sorry that you having issues post your breast augmentation. Your frontal view, implant information and before pictures would have been helpful. The picture shows double bubble, but you need to wait and let your surgeon fix it.

Patrick L. Basile, MD · Answer

It is too early to tell the ultimate result. I would wait 3-6 months before seeking revision surgery.

Jourdan Gottlieb, MD · Answer

I can see the indentation that is present, but it is not sufficiently in focus to get much detail.  Before photos would also be helpful.There are a number of possibilities. This could be an indentation from the original site of the breast fold if that was lowered. It could be an impression from the lower edge of the pectoralis muscle. Either of those are likely to improve as the tissues stretch out over the next months of healing. I concur with your surgeon's advice--patience.  All the best.

Shelby K. Brantley, Jr. MD · Answer

Hey Shar86.  I agree with your surgeon.  You will need to give your breast another 6-8 weeks to settle down more.  Your implants will continue to settle into the pocket and that should resolve.  I would definitely keep your eye on it and make sure it does not get any larger or develop soreness and redness.  Be patient and in my opinion, this is not a 'double bubble'.

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