Double Bubble or Bottoming Out? Options to Deal with This and Large Gap Between Breasts. (photo)

I got breast implants 6 months ago (round, smooth, silicone, 300cc, 12cm wide submuscular). Pre-op my left breast was 12.2cm wide, right was 13cm. 3 months post op when I flexed only there was a double bubble in the left. Recently I noticed that the double bubble at the crease even when I'm not flexing. What are my options? Should I go over the muscle? dual plane? If I had to have surgery again I'd like the wide gap between my breasts fixed, do you think this is possible? How? Im 110 lbs 5ft2

Doctor Answers 6

Double Bubble or Bottoming Out? Options to Deal with This and Large Gap Between Breasts.

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Look at your before photos. You had/are wide set, volume issues with asymmetry, anatomic irregularities. The post operative views are not perfect but are very acceptable. The muscular ridge is the pect muscle, correct by further surgery can be done. Choices are relocate the plane of the implant, cut the muscle even more, fat grafts to camoflague the crease. The infra mammary folds need correction also.Best to seek in person evaluations. 

Double Bubble

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It would be my impression that you would benefit from a capsulorrhaphy to correct the double bubble. If the creasing is severe with animation, this can be from too much release of the muscle when the surgery is done. Sometimes with the resuturing of the fold this can improve.

Most every lady wants more cleavage. The gap between your breasts can be improved by release of the pocket but there are limitations due to your own anatomy (sternal bone width). Discuss this with your surgeon.

Scott R. Brundage, MD
Grand Rapids Plastic Surgeon
4.8 out of 5 stars 26 reviews

Breast Implant Displacement Correction?

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Thank you for the question and pictures.

I think you will benefit from revisionary breast surgery which will likely involve the use of internal sutures ( capsulorraphy) to repair the breast implant displacement inferiorly ( left breast). Whether or not lateral breast capsule sutures are also necessary will depend on whether the breast implants displace to the side when you lie down.  It is possible that larger/wider  breast implants  will be necessary to decrease the gap between the breasts as much as safely possible.  As you can imagine, careful communication of your goals between you and your plastic surgeon will be critical to the success of the operation.  I think careful limitation of postoperative activity after this type of surgery is also very important when it comes to the success of the operation.

I would not suggest that you change the breast implant position to the sub glandular position.

 I hope this, and the attached link, help.

Double Bubble or Bottoming Out

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Since this is present at rest, this is most likely a double bubble caused by bottoming out, which occurs when the implant descends, lifting the breast fold off of the chest wall. 

Another cause is an indentation caused by the lower edge of pectoralis muscle when flexing, and this may occur to at least a minor extent in all submuscular patients. 

A third cause of what some call double bubble is a patient with an augmentation who needed but did not have a lift.

Treatment depends upon the cause, which is best determined on examination.

For the first cause, reinforcing the breast fold, sometimes with a product like Strattice, is the treatment. 

For the second cause, correction of the muscle contraction by one of a number of techniques is done

For the third, a breast lift. 

As to the width of the gap, that is because of your natural breast position, and in terms of the outcome, other than the double bubble I think this looks good and I would not advise tampering with the gap. 

Thanks for your question, best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

How to treat double bubble/bottoming out

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Often times a double bubble deformity and animation have the same cause and therefore the treament needs to account for the underlying issue. I believe the cause is often the way the muscle is cut for the dual plane procedure. The muscle then heals into the scar capsule where you can see it pulling when you flex. If the pulling is where the crease is then that is the problem. This can be fixed by converting to what is called the split muscle method. I would be happy to send you a copy of my article on this. Bottoming out may also have to do with the muscle which can push down on the implants.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 56 reviews

Double bubble

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You have a double bubble. You will need a capsule repair inferiorly and possibly an exchange for a smaller implant. 

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.