Is This Double Bubble?

Had BA on 7-8-11. PS never mentioned I would or might need a lift and am wondering if he missed the mark here. I am 7 weeks post op and am curious if this is double bubble or something else. He has me wearing strap 24/7 and I see slight improvement but am not sure. If I need revison what are my options? This is 450 cc silicone dual plane. I know it's early on but ps swears it should self correct. Thanks

Doctor Answers 11

Double bubble after breast augmentation

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Yes, unfortunately this is a double bubble and unfortunately, I doubt that it will resolve with time (but stranger things have happened). If revisionary surgery does become necessary, I think my 1st choice would be reconstruction of the inframammary fold area  using permanent internal sutures (capsulorrhaphy).  Excision of skin may or may not be necessary (breast lifting).

You are correct that is still early in your post operative course and any revision surgery should be done many months down the line.  Continue to follow-up with your surgeon but make sure he/she is a well-trained/experienced board-certified plastic surgeon (especially if/when it comes to revisionary breast surgery).

Best wishes. 

What to do with early double bubble

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This is a moderate double bubble, caused by the surgeon lowering the fold in an attempt to get the implant to sit lower on the body so that the breast does not fall over the top of the implant. Sometimes this works. Sometimes the original fold is very tight and will not relax, thus creating the indent. Think of a belt on a fat guy. There is a roll above and below the tight belt. I would wait it out and see. It might stretch out and correct in a few months. Do you have it symmetrically on both sides? If it doesn't correct, there are several options.

1. tack the fold back down where it used to be. This will correct the bubble, but a lift might be required.

2. place the implant above the muscle in a new pocket.  The lower skin can be left attached to the original fold so the implant can't drop back down into the old space.

Good luck.

John Alexander II, MD
San Diego Plastic Surgeon
4.8 out of 5 stars 13 reviews

Breast Implants - ? Double Bubble

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It is a double bubble - not the most dramatic version but, nevertheless, that's what it is.  And it's caused by having a narrower base of the breast versus the implant, a bit of sagging, or a combination.  Pre-op photos might help determine what the origin is.

In general, if you have only a small amount of sagging, and the base of the pocket (where the indentation is) was opened enough during the surgery, the implant may settle into the new pocket and keep that portion open.  It is fairly common to see this appearance early on (at only a few weeks post-op) even if the pocket was opened enough during the surgery.

At 7 weeks, though, I would start to be a little concerned that this may not stretch out enough on its own.  Has it been like this since the beginning?  Is it getting better or worse?  If it was worse and this is all that's "left," you may be fine without having anything done.  If it continues to be like this, however, and you are not happy with that appearance, then it may require another procedure; either to open the pocket up or, possibly, to consider a different procedure.

This is where it gets more difficult.  Did you discuss the possibility of needing a lift with your plastic surgeon, did you go for several consults, etc.  It's very difficult to say another specific without knowing the answers to these questions.

I hope that this helps, and good luck,

Dr. E

Breast Implants and Double Bubble Deformaty

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Hello Lay72,

Unfortunately you do have a double bubble deformity.  Yes, it is still early, but I've never seen one resolve completely.  The reason you have this issue now is that prior to your surgery you had a very short distance between your inframamary fold and the bottom edge of your areola with the inframammary fold positioned high on the chestwall.  This condition makes the position of your nipple and areola relatively low on the breast mound.  A common mistake made is choosing a large implant to try to 'lift' the nipple upwards on the breast mound, which never happens.  The surgeon ends up violating the inframammary fold by lifting it off of the chest wall in an attempt to place the implant low enough with respect to your nipple position. The band you are wearing 24/7 is only pushing the implant lower on the chest wall, accentuating the problem. 

If you would like a smooth curve to the appearance of the bottom of your breast you will need a revision surgery that will address all the issues you are having: 1. too large an implant  2. inelastic skin of your breast 3. low lying nipple position.

Revision surgery is difficult and requires a specialist who does this type of surgery often. I recommend seeing a few surgeons who specialize in breast revision surgery and are certified by the American Board of Plastic Surgery.  These surgeons are usually members of the American Society for Aesthetic Plastic Surgery as well.

Best of luck.

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Double bubble??

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The picture that you are showing is a proverbial 'double bubble'.  It's hard to completely comment for you the reasons for it in your case and seeing your pre-op photos would help.  The fact that you claim to have had a 'dual plane' procedure- which I assume is terminiology that you got from your surgeon- tells me that you had some somall amount of ptosis (droopiness) identified before the procedure.  The dual-plane technique is used to help the breast to elevate over the muscle to avoid a lift in very minor situations.  IT's surprising that a formal lift was never even discussed if a dual-plane procedure was discussed.  That said, this may correct itself a bit as time goes on and the lower edge of your muscle stretches out.  At the 7-week point it's still early enough and I would give yourself the 'benefit of the doubt' and wait it out a bit.  My sense from the photo is that this isn't going to correct completely.  Good Luck!  Scott Newman, MD FACS

Scott E. Newman, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 42 reviews

Agree with the group.

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I agree the consensus here. The phenomena is produced in people with strong inframammary attachments that will produce that "memory" of the old fold when lowered. As you nipple to fold length is so short, it's likely this was unavoidable to accomadate your implant (assuming the fold had to be lowered).

Is This Double Bubble?

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Yes, great photo of it. This issue can be resolved over more healing time, like 3 months. But revision could be another option. 

Double Bubble Deformity

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From your photo, you do not appear to have a "double-bubble".  A double bubble exists when the lower portion of the implant lies beneath the inframammary fold and yours does appear to do this.  This deformity and other problems are more common when implants are used that are too large.  Whether or not you need a breast lift is another question which I cannot answer with the view of your breast in the photo that you provided.

John Whitt, MD (retired)
Louisville Plastic Surgeon

You have double bubble

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Your picture shows double bubble and it can be due to multiple reasons. The issue is what to do about it. This will not correct itself and will need revision. Your implants are too big for your breast base. You will need to get smaller implant and lift. You have fair amount of breast tissue that your implant has not filled and it falling off the implant.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

This is a double bubble

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Your picture does show a double bubble with the implant extending below the breast envelop and the tight breast fold above. Your surgeon may be right, and over time the fold and envelop can relax and blend better with the pressure of the implant. Keep a positive outlook if you like the size and see if things straighten out.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

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