Do you think this is double bubble? (Photo)

I am 10 weeks PO. Do you think this is double bubble? I saw my ps and he said it is just my crease from my natural breast. He said that it shouldn't get worse. He also said that because I didn't have much of any underboob that my incisions won't be hidden. That my boobs should continue to look like this. Should I trust that he's telling me the truth or is a revision needed. The lines in my breasts look much worse when I flex. Should I prohibit doing any exercises that use my chest muscles?

Doctor Answers 9

Double bubble

Thank you for your question. In looking at your before photos you did not have much tissue in the lower portion of your breast- this is known as constricted breast. The indent you are seeing is more than likely the bottom of your original breast with the implant seen underneath (commonly known as double bubble). It is possible that this will get better as your tissue stretches to accomodate the implant over the next three to six months. If it is not to your liking at that time your inframammary fold can be repositioned to the original fold height to eliminate this- keep in mind that your implants will sit higher and your nipples will look low. As to the worsening  of the fold with chest flexion- this is known as animation deformity and occurs when the implant is placed beneath the muscle. The upside of having your implants under the muscle is a lower risk of capsular contracture and better tissue coverage of the implant at the top portion of the breast. Sometimes releasing the inferior border of the pectoralis will help with this. In order to have it go away completely you would need your implants moved to a subglandular plane, which I wouldn't recommend given your preoperative photos.  I hope this helps! Try to be patient. Best wishes, Dr. Meghan Nadeau, Seattle, WA

Seattle Plastic Surgeon
5.0 out of 5 stars 5 reviews

Double bubble

It is hard to tell exactly if you have a double bubble deformity or if it is your pectoralis muscle making that crease. If your surgeon lowered your inframammary fold, then you are likely seeing your old fold which is a double bubble deformity and can be repaired by closing that area down and using your natural fold instead. If it does actually get worse when you flex, then it may be the pectoralis muscle that could be released more to allow the fold to get softer. You should be able to do your normal work-out routine after breast augmentation - including upper body and chest work-outs once you are completely healed. Best wishes.

K. Roxanne Grawe, MD
Columbus Plastic Surgeon
4.9 out of 5 stars 137 reviews

Do you think this is double bubble?

I am sorry to hear about your concerns after breast augmentation surgery.   It looks like you have a double bubble contour problem. 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.
There are several options when it comes to revisionary surgery to improve your outcome.  One option is to eliminate the pull of the pectorals major muscle either by completely releasing it or by suturing the muscle back down, thereby placing the breast implants  in the sub glandular position.  Patients who choose to have breast implants placed in the sub  glandular position should have enough breast tissue coverage to allow for this conversion. There are disadvantages of placing breast implants in the sub glandular position (such as increased risk of breast implant encapsulation) which should be considered as you make your decisions.

Another maneuver that may be helpful is raising the inframammary fold using capsulorraphy techniques. In my practice, this type of repair involves a two layer, permanent suture repair (reconstructing the inframammary fold areas).  This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation. Sometimes, depending on factors such as quality of skin along the lower breast poles, additional support provided by acellular dermal matrix or biosynthetic mesh may be very helpful. I have also found the use of acellular dermal matrix very helpful in cases where the skin/tissues are very thin and in cases of recurrent breast implant displacement. The acellular dermal matrix helps improve contour, improves irregularities caused by the underlying breast implant and/or scar tissue, and provides additional support ("sling" effect) for the breast implants.
I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Breast augmentation - do I have a double bubble?

Thank you for asking about your breast augmentation.
  • It is a little hard to say from your photos -
  • It looks and sounds as though the indentation is caused by the lower border of the pectoral muscle 
  • But if your surgeon released your breast crease it might be an early double bubble.
  • The best thing to do is to give yourself time and see how you heal.
  • If the implants move further down - it is a double bubble.
  • If they don't move down but the crease persists, you may need a revision to release the muscle or put the implants over the muscle.
  • If you were my patient, I would want you to keep up your exercises.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Double Bubble

Thank you for your question and photos. There does appear to be constriction remaining where your previous crease was and you may find that this gradually stretches out and softens over the next few months. I recommend that you follow up with your Plastic Surgeon if muscle related animation deformity continues to be an issue.
All the best

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Double bubble?

Your preops suggest that you had a tight lower pole. The line you see may represent the original inframammary fold. This may improve with time.  Best to review with your surgeon.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Double bubble

From your photos it appears you may be developing a double bubble. It is still early in your healing process and the pectoralis muscle has to stretch some more. Once the implants settle more and the muscle stretches it may improve.

Deborah Sillins, MD
Cincinnati Plastic Surgeon
5.0 out of 5 stars 11 reviews

Do I have a double bubble?

From your photographs, you started with a very small base width which necessitated a lowering of your breast fold in order to accommodate the size implant that was placed. This can sometimes create two bottoms, one of which is the old crease ,and the other caused by the bottom of the implant. We call this a double bubble. If it is worse dynamically, meaning when you activate your pectoralis muscle, then some tightness of the bottom portion of the muscle may be causative. As the distance from the bottom of the areola to the new crease stretches with gravity, this may improve. Likewise, as the pectoralis muscle stretches, should that be the cause, this still may improve. I would give it several months before I would entertain going back to remedy it. It is certainly fixable with a small touchup. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Double bubble?

A so-called double bubble deformity is a visible demarcation between the gland and the implant underneath it.  In your case, you had a tight fold with short nipple-to-fold distance.  The implant position looks OK (?right might be a bit low) but the old fold is still clearly visible. You can expect variable degrees of evolution of the breast shape over time depending on whether you have a textured or smooth implant, what was done to the fold and the surrounding soft-tissue support, etc.  It is possible that the crease from the old fold will become less visible with time, especially if the fold and breast gland were scored during surgery.  It is also possible that it will get worse. Double bubble deformity can be corrected if it persists but can be tricky to fix.   At this point you will have to wait to see how your shape evolves.  

Andrew Wolfe, MD
Denver Plastic Surgeon
5.0 out of 5 stars 130 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.