Double bubble repair. (photos)

Question

Am I stuck with these lines across my boobs? I'm going to go back under to repair the left side because "it hangs lower" not because of the lines. Dr said he would suture that side to my ribs. However I'm still worried about the lines on both sides. One side is worse than the other. Will the less noticeable one get better? Hypothetically, if I were to re-do my boobs can I get more of a rounded cleave look like in the other person's photo? I have high profile 550cc. Why do I have the lines?

Kenneth Dembny, II, MD · Answer

Yes those lines are most likely permanent unless something is done surgically to correct them.

Those lines represent your native inframammary crease, which is now visible as a division between the contour of the implant and the contour of the breast tissue. What you are seeing is described as a "double bubble" deformity.

A double bubble deformity occurs when the implant is placed in a submuscular position. When the implant is placed too low (or settles too low), the bottom of the implant is positioned below the level of the native inframammary crease; and the shape of the implant differs from the contour of inferior pole of the breast above the level of the inframammary crease). The ‘bubbles’ are defined by the persistent visibility of the inframammary crease.

A double bubble deformity is more likely to occur when the (pre-op) native inframammary crease has a higher well-defined position and the breast tissue overhangs it slightly, when the inframammary crease is (inadvertently) lowered too much during surgery, or if large or over-sized implants are placed.

Typically following most augmentations, when the inframammary fold has been lowered, the native  inframammary fold is no longer visible after surgery -- although this does depend upon the shape of the breast, inframammary fold anatomy, the size/shape of the implant, and the surgical dissection. If the native inframammary fold is 'softer', and the appearance of the native fold is subtle after surgery, then the native fold may stretch and the breast shape will be normal. But if the native inframammary fold is 'tighter', then the native fold is unlikely to stretch after surgery, and as the implant settles the double bubble deformity will appear or become more evident.

Correcting a double bubble deformity requires removal of the breast implant, partial inferior capsulectomy (if the surgeon desires), and then placement of internal sutures to raise and reconstruct the level of the fold. This is best done thru an incision along the inferior border of the areola or along the inframammary crease. When the initial surgery is performed through one of these approaches the incision can be re-opened. If the initial surgery was trans-axillary, then the repair will require one of the approaches (incisions) described above.

Speak to your surgeon about your concerns and see what recommendations s/he gives you. With the larger implants you have selected this may be difficult to correct, but raising the position of the implants may be helpful. Utilizing even larger implants is not likely to solve your problem.  Best wishes.

Richard Baxter, MD · Answer

There are two possible causes of double bubble. The most common is lowering the fold below the anatomic lower edge of the breast, resulting in a crease across the breast. If you measure the distance from your nipple to the bottom of the breast before surgery, you will see that this is much shorter than the distance from nipple to fold in the goal picture. Another cause relates to animation deformity. If you see the crease pull up when you flex your pectoral muscle, then the crease is caused by the muscle pulling on the scar capsule. That requires a different type of repair, such as conversion to the split muscle plane (not dual -plane.)

Daniel Del Vecchio, MD · Answer

The other surgeons have done a great job explaining the  size of the double bubble so i will spare repeating.  there is a non surgical technique that has recently been described that uses a long shoelace sling wrapped around the breasts.  The plastic surgeon who invented this is Daniel Mills, MD, the current president of the American Society of Aesthetic Plastic Surgeons.I would look into this before having more surgery - i have attached a linkbest of luck-

Steven Wallach, MD · Answer

The double bubble may be related to the breast fold being undermined. Often this requires a capsule repair. Best of luck.

Karol A. Gutowski, MD, FACS · Answer

There is a limit to what size breast implants each woman's breasts can take. Excessively large implants may cause a double bubble if the breast crease has to be lowered. Trying to go even larger will not fix it.

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