Double bubble. What is the best way to fix this?

Question

I had a breast augmentation about 3 years ago and I have had a double bubble shortly after my surgery. I read that there are 2 ways to fix it, by getting rid of some skin underneath to look round again but the nipple can face down after that or fat grafting. I also read the downside with fat grafting is that it may seem like a tumor on imaging and it has happened that the patient had to go under and they realized it's just a fat. I would like to know which option is the best one to do? Thanks

Richard Baxter, MD · Answer

There are more than one cause of double bubble so the correction depends on which it is:If you had a short distance between the nipple and the bottom edge of the breast (inframammary fold or IMF) then the double bubble is the original IMF appearing as a groove across the bottom part of the breast. That may be best corrected with fat grafting or exchange to a form-stable shaped implant. Another option would be smaller implants of a narrower diameter, and pocket revisions to place the IMF back where it started.If that was not the case then it may be the implants dropping below the fold. This is fixed with a pocket revision called a capsulorrhaphy.Animation deformity can masquerade as double bubble. That occurs when the released muscle adheres to the scar capsule, and you would see the groove on the lower part of the breast pull upward when you contract your pectoral muscle. That requires a more elaborate revision.

Brian C. Reuben, MD · Answer

Thank you for your question. Best way to think about a double bubble is that it’s a structural problem:  the implant has slipped down under the supporting ligaments of the breast.  This type of problem needs a structural fix:  repairing the bottom attachments of the breast.  Fat grafting does not repair this and is a mere “cover up” of the underlying problem.  For small double bubbles, this can sometimes be reasonable.  However, for most problems, it will fall short of a good fix.  Best wishes.

Gerald Minniti, MD, FACS · Answer

Double bubble is a problem of the implant interposing itself between the chest wall and the natural inframammary fold, usually due to a disproportionately large or projecting device. Removing skin is only appropriate as an adjunct to fixing the problem if there is also skin excess prior to surgery; in other words, the patient also needed a lift prior to the implant surgery. Fat grafting is talked about, but I've yet to see a case where it worked effectively. That is because there is very little room to place fat where it is needed: in the depth of the crease, an area with little space and high interstitial pressures, and vertically oriented, tethering fascia (which is the 'stuff' that creates the fold), making fat survival unlikely. The gold standard for correcting double bubble is to resize the implant pocket by closing it down, either with sutures (capsulorrhaphy), biologic material known as ADM, or absorbable mesh (internal bra, my preference).

Eugene Kim, MD · Answer

It's difficult to answer your question without examining the breasts.  If the breasts don't have excess skin, a lot if times the double bubble can be corrected with internal sutures.  I recommend seeing a plastic surgeon for consultation

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion of my practice is dedicated to revisionary breast surgery.  I find that the most common cause for a double bubble is dissecting the pocket underneath the inframammary crease ligament.  The repair requires a capsulorrhaphy-suturing the capsule and inframammary ligament back to the chest wall and mirror image capsulotomy.  I find this is very effective in almost all cases.  Best wishes to you.

Daniel Barrett, MD · Answer

Dear Passionate2437,
though rare, some women who undergo breast augmentation will develop a minor deformity known as a “double bubble,” in which additional folds appear underneath the breasts due to the implant accidentally shifting or contracting post-surgery. In most cases, the implant simply slipped too far down the chest wall and traveled behind the breast inframammary crease (the area where the lower breast meets the chest), instead of moving forward to fill the breast cavity. If left untreated, the lopsided implant will form unnatural indentations, resulting in an odd “four-breast effect” rather than the full, rounded chest the patient initially desired.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Milind K. Ambe, MD · Answer

I am sorry to hear of your situation.  I do not trust fat grafting because the results are very unpredictable.  It is hard to say what should be done in your case because i do not see any photos, and an in person exam is best.  However usually pocket tightening (capsulorraphy) and maybe removal of some skin in the inframammary fold region is often an option.  I would recommend you seek in person consultations with board certified plastic surgeons in your area for more detailed information.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question but a review of your operative note and preop photos as well as an examination is really needed before making a recommendation.   So get those records and go on some complimentary consultations with experts and compare recommendations after a full examination and discussion of desired results Dr Corbin

Double bubble. What is the best way to fix this?

Answers (8)

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