Double Bubble, Asymmetry, and What Needs to Be Done to Correct This? (photo)

I had my breast augmentation done 7 months ago. I'm 5'1", 127 lbs, and 26 years old. I have 304cc gel implants, transaxillary approach. I think I have a double bubble in both breasts and asymmetry going on. I'm very upset with the results from my surgery. Is the correctable and what would need to be done to correct this issue?

Doctor Answers 8

This can be corrected with that transplantation.

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Double bubble deformity can be due to several causes. One very underappreciated cause is the native inframammary folds remain persistent and fail to re/drape over the lower pole of the breast implant. This is often seen in cases of inadequate soft tissue in the lower pole of the breast.   In your case, the right breast implant is also placed too low. These cases can be successfully treated with fat transplantation to the Lower pole the breast and release of ligamentous bands that are creating the deformity.

Double Bubble, Asymmetry, and What Needs to Be Done to Correct This?

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Sorry for the result! Yes you will need revisional surgery. Options are capsulectomy with riggotomies to release the constricted folds + fat grafting. But you truly need IN PERSON second opinions for your issues. 

Yes You Have Double Bubble and Yes This Can Be Corrected

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Hello, yes you clearly have double bubble anatomy and more on your left and some asymmetry. If this is 7 months then what you see is what you get. I have corrected this many times and very predictably. It involves removing the implants through your same incision and then making criss-cross cuts in your capsule and inframammary ligament and adjust the breast space so that your implant, whatever size you want, is centered behind your nipple, there is a slope to the top, roundness to the bottom, and a natural look. Your original surgeon should be able to do this just fine.

James Romano, MD
San Francisco Plastic Surgeon

Double Bubble Asymmetry and Revision Breast Surgery

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Thank you for the question and photos. Its clear that you do have a "double bubble" deformity; which occurs when the implant is below the breast. The lower pole of the breast is defined by the IMF or inframammary fold. Implants can sometimes go below this anatomic structure. I agree this will not resolve or get better on its own. I would advocate a staged mastopexy/ augmentation: the first stage recreating the fold and placing the nipple in the proper position and then 3 months later, when everything has healed, augmentation.

Stephen M. Becker, MD
Knoxville Plastic Surgeon
5.0 out of 5 stars 47 reviews

Double bubble after breast augmentation

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Dear BY.  Sorry to hear about your problem.  You definitely have a double-bubble (the implants are too low).  To fix this, a capsulorrhaphy (capsule repair) needs to be done.  This means the capsule pocket is made smaller in the lower half by putting sutures in the capsule itself to tighten it up.  The upper part of the pocket is then opened up to allow the implant to move up toward your collarbones.  There is chance you would need some type of lift to get the nipples positioned correctly, but you would have the chance to wait 3-6 months after the initial revision before deciding if you really want the lift.

Double Bubble, Asymmetry, and What Needs to Be Done to Correct This?

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Thank you for your question and the attached photos. The preops are very helpful in reviewing the case. 

Clearly a double bubble is present on both sides. I would imagine that your surgeon may have tried to lower the folds to avoid having to do a breast lift. What you are looking at is the original breast fold causing the indentation on the implant, and the new "fold" that is too low. 

At this stage to fix this you will need to have the breast fold reconstructed preferably through an incision in the fold, or maybe around the areola. With the implants in the proper position, a breast lift may also be necessary to avoid the look of a downward pointing nipple and areola. 

Best wishes. 


Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Breast position

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It appears as though your implants are too low which has violated your crease below your breasts. I would follow up with your plastic surgeon as this appearance rarely improves. Good luck

Timothy Fee, MD
Jacksonville Plastic Surgeon
4.3 out of 5 stars 58 reviews

Double Bubble, Asymmetry, and What Needs to Be Done to Correct This?

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I am sorry to hear about the complication you have experienced. The double bubble phenomenon usually represents  a problem along the lower pole of the breasts,  where one can feel/see the breast implant below the “previous” infra mammary fold area. One “bubble” is caused by the breast implant, the other by the breast tissue.

Reconstruction will likely involve the use of sutures to repair the breast implant capsule and reconstruct the inframammary fold areas. The use of additional supporting material such as acellular dermal matrix or biosynthetic mesh may be helpful also.

Make sure that your plastic surgeon has significant/demonstrable experience helping patients with this type of revisionary breast surgery. You may find the attached link helpful to you as you learn more. Best wishes.

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.