Double bubble repair. (photos)
Doctor Answers 5
Understanding double bubble troubles
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.)
Thank you for your question. Your double bubble was caused by the destruption of the natural breast fold due to the placement of the implant. The size of your implant exceeded the natural boundary of the breast and, in order to allow the implant to drop properly behind the central portion of the breast, disruption to the fold occurred. There may have been the surgeons contribution or simply the inability to contain the implant within the natural lower portion of the breast. Over time, stretching of the lower half of the breast may occur and, with revision, may actually improve the shape with revision surgery. However, the size of your implant raises concerns about whether or not correction of the fold deformity can occur even with revision surgery. Although you may be concerned about a smaller implant, this would certainly improve your chances of an improved repair. With regard to the cleavage, no implant can change the natural gap distance between the btrasys and this is where fat transfer may actually help to improve the contour and close that gap as well. I would discuss these matters with your surgery. I hope this helps and have a wonderful day. Dr. Kayser - Detroit
The double bubble may be related to the breast fold being undermined. Often this requires a capsule repair. Best of luck.
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Double Bubble Deformity Following Placement of Large Implants
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.
Double bubble repair
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.
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.