Is This a Double Bubble or Am I Bottoming Out? How Should This Get Repaired? (photo)

I got my saline BA 6 yrs ago. I got capsular contracture on my left breast. My PS used my original implant.I could tell immediately that the pocket was too low. My PS said that I need to wait a couple of months so the implant would lay over the fold. When I went a couple of mths later he said that it would need to be fixed. He is going to put stitches to fix where the fold should be. He said that he will not even have to take out the implant. I'm scared that this will be a temporary fix.

Doctor Answers 10

Is This a Double Bubble or Am I Bottoming Out? How Should This Get Repaired?

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Double bubble and bottoming out. The implant has an indentation that is clearly visible-this is the double bubble. The implant is lower on the same side, due to bottoming out.

The rebuilding of the breast fold is what you are describing, but that alone will not resolve the double bubble. I am not sure of the meaning of not taking out the implant, but fixing the indentation would be quite difficult with the implant in place. 

All the best. 

Seattle Plastic Surgeon

Implant Exchange with Mini Ultimate Breast Lift

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I recommend a new technique called Implant Exchange with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to exchange your implants, reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall gives maximum anterior projection with a minimal size implant.  Your implants need to be removed and smaller implants placed totally retro-pectoral.  This will resolve your deformity and you will be able to achieve the projection with smaller size implants that are stable long term. 


Best Wishes,


Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Double bubble sometimes best treated by removal of implants and delayed replacement.

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You definitely have a problem with your breasts. Cautious way to address the problem would be to remove both implants and allow the chest wall to heal. If you much can come back and replace them as though it were first-time breast augmentation. Also consider changing the location of the pocket.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 41 reviews

Repairing the bottomed out double bubble

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can be challenging and this is where you need to ask your surgeon just how he plans to accomplish your  goals.  Does simply elevating the fold to match your fold on the right remove the stigmata you have?  There are many ways to elevating folds and some work better then others.  What happens if it doesn't hold?  Realize you likely won't have perfectly matching folds as well.  And how does he intend for your implant to be supported while you are healing?  Find out the details and what is expected of you during the recovery process and then decide if that is the right thing for you.  You will have a very important role in the outcome.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Is This a Double Bubble or Am I Bottoming Out? How Should This Get Repaired? (photo)

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Basede upon the posted photo you have a combination double bubble + bottoming! But I do not understand why the 6 year wait??? 

Bottoming out and double bubble

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In fixing this problem, the fold needs to be resuspended. I prefer to place a smaller implant in because the breast could not handle the large implant in the previous procedure and the pocket will be made smaller.  Best to be seen in person.

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

Correction of bottoming out and a double bubble deformity

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This is a form of the double bubble deformity coupled with bottoming out.  The crease that you see is due to the your original breast tissue and original crease being held well above the low current inframammary crease.  Your breast on this side also looks larger.  Correction of this problem may include creation of a new breast implant pocket, using a smaller implant and securing the new inframammary crease at a level even with the opposite side.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Understanding cause of double bubble/bottoming out is key to successful repair

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One thing that is very important to appreciate is the relationship of animation deformity to double bubble; although you don't mention it, I am certain that when you flex your pectoral muscle on the left that you will see pulling up where the crease across the breast is. It is caused by the muscle attaching there and is not the original fold. (Look at the distance from the crease to the areola and compare it to the right - was the original fold only about an inch and a half from the areola on the left but 3 or 4 on the right?) This will not likely be successfully repaired with sutures only. Consider converting to the split muscle plane or use of Strattice. I would be happy to send you a copy of my article describing this procedure.

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

Is This a Double Bubble or Am I Bottoming Out?

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Unfortunately you do have significant downward displacement of the breast implant below the fold. I have had very good success over the years doing suture repair of this problem and almost never see a recurrence. It does take a lot of experience however and many doctors feel they can get a better esult by sewing in an allograft as a sling. This works very well but is quite expensive. The alloderm is certainly  better if the implants are quite large and heavy and I would give more thought to that procedure if your implants are over about 500-550 cc.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 28 reviews

Double Bubble or Am I Bottoming Out? How Should This Get Repaired?

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I am sorry to hear about the complication you have experience. Your photograph demonstrates breast implant displacement ( with medial and inferior “bottoming out”).

 Revisionary breast surgery will likely involve internal sutures (capsulorraphy)  to “reconstruct” the inframammary fold areas.    This procedure involves removal of a segment of breast implant capsule among the inferior/lower aspect of the left breast implant pocket. The two edges of  capsule tissue are sutured to one another. This procedure reduces the size of the implant pocket and prevents the descent  of the implant on the involved side. This procedure will improve the symmetry of the breasts  and the positioning of the nipple–areola on the  breast mound.

Careful restriction of postoperative activity will be one of the keys to success with this revisionary breast surgery.

I hope this, and the attached link, help.

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.