Double Bubble or Bottoming Out?

(Revised) I had my surgery on June 24, 2010. I was a 34A and got 533cc silicone implants. At the 3 month mark I started to notice something was off. The incision was under the fold and my surgeon promised that it would not be noticeable, and that this was the only way to fit such a large silicone implant along with lowering my crease, so i trusted him. My incisions have always stayed exposed and I can feel and see my original crease. I thought the skin would stretch out with time. Is it fixable?

Doctor Answers 5

Breast augmentation revision - double bubble

Your current implants are appropriately positioned as they are centered under the nipples. The problem is they are just way too large for your body so the bottom edge extends below the edge of your actual breast. You will have to go to a smaller diameter implant if you want to fix this and get rid of the double bubble. If you just use the same dimension implants and move them up the implants will no longer be centered under your nipples. I do not think you will be happy with the look of implants sitting high up on your chest.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Double Bubble

Hello CatieChloe,

I am sorry that you are unhappy with the appearance of your breasts after your augmentation. I did not read the responses of your first posting, but took special notice of the second.  I take issue with the what has been said so far with regards to the implants being inferiorly placed.  It actually appears as though they are well centered below your breast mound and nipple areolar complex (approximately).

The real issue is that you were an A cup with a well formed inframammary fold and relatively inelastic breast tissue (I am supposing), and you and your surgeon chose an implant that was inappropriately large (too wide, too projecting) for your anatomy. In a vain attempt to get you to look right on the operating room table, and not look like the implants were resting on you collarbone, he opened the pockets up well below the inframammary fold, allowing the implants to lift the fold right off your chest wall.  Had your breast tissue been more compliant, he might have 'gotten away with it', but your breasts could only expand so far, and the rest was taken up by your chest skin, which is now covering the lower edges of your implants.

It is true a repair could be executed utilizing the same sized implants, but I suspect you will be left with implants that are riding too high on your chest wall (another common problem seen here on As I have said so many times before:


One can't simply pick out an implant size based solely on aesthetics, like picking out a pair of shoes. This thinking is the root cause of most complications that lead to early and unexpected reoperations, and is usually associated with inappropriate implant size or profile. There needs to be an overhaul of the whole process of breast augmentation, towards an objectively defined process that can be measured, an appropriate implant chosen based on those measurements, and real data obtained. It really is not about what size or shape you think you want, its about the right implant size for your anatomy.

It does not matter what the technique used to repair your problem, either acellular dermal matrix (ADM) or capsular plication (capsulorrhaphy), the inframammary fold needs to return to the chest wall, otherwise some form of double bubble will remain.  Once your fold is returned to its appropriate location, there will be little room for a 500+ cc implant to sit properly under your breast mound, and it will occupy your upper chest wall above the nipples. I implore you to reconsider implant size if you are to undergo a reoperation.

Reoperation is not a simple task and should be performed by surgeons well experienced in complex breast implant repair.  You may want to consult with a few surgeons with this reputation. Naturally, they will not only be certified by the American Board of Plastic Surgery, but also be members with the American Society for Aesthetic Plastic Surgery.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 90 reviews

Bottoming out and double bubble are often related

You have a problem that is not uncommon. It happens with large implants particularly when your previous breast crease was fairly high and deep set, perhaps with a little bit of droop to the lower breast. The line creating the double bubble and in which your surgeon placed the incision represents the bottom of your old breast and the natural crease from before.  Now the implant has slid below this line or perhaps was deliberately placed there.  It is more of an issue with larger implants because of their bigger diameter which forces the surgeon to place more of the implant lower down.  Solutions you need to talk to a plastic surgeon about are re-suturing the old crease by means of internal sutures (capsulorrhaphy).  This would likely be more successful with a smaller implant.  The other solution to discuss with your surgeon is using your own fat as a graft taken with liposuction and injected into the crease area.  This is a new concept and works well in many cases. It may be your simplest choice.

Nicholas Carr, MD
Vancouver Plastic Surgeon
3.5 out of 5 stars 16 reviews

Bottoming Out of Breast Implants And “Double Bubble”?

Thank you for the question and pictures.

The “double bubble” appearance that you are noticing is related to the breast implants that are inferiorly position. As discussed in the previous answer to your question,  repair is possible using internal sutures (capsulorraphy). This procedure will serve to reconstruct the inframammary fold area, correcting the implant malposition and improving the contour ( double bubble effect).

Best Wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,502 reviews

Bottoming out and double bubble

Bottoming out can lead to double bubble in some patients. This is when the implant goes below the original fold and the fold tissue does not stretch out. Often the correctionis to re-attache the fold and sometimes put in a smaller implant.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 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.