Double Bubble Correction 3 Months Post Op too Soon? (Photo)

I had a breast augumentation (Natrelle 360CC moderate teardrop implants)3 months ago. Surgeon lowered the breast fold,implants are under muscle.Unfortunately one breast shows the double bubble effect:-( My surgeon wants to wait and see and correct DB by making cuts in the muscle or putting the implants over the muscle. - Correction also possible 3 months post op? - Better make cuts in the muscle or putting implants over muscle? -Change to round hp implants for better shape and upper pole? Thx

Doctor Answers 6

Correcting double bubble

Double bubble is a difficult problem to correct.  The implant has descended below the inframmary  fold.  I personnally would not switch planes or cut the muscle.  I would consider a neosubpectoral pocket with resetting of the fold.  I feel this will give you the best result and enable you to preserve the subpectoral pocket.

Bethesda Plastic Surgeon
5.0 out of 5 stars 6 reviews

I don't think you have a double bubble deformity...

It seems to me that you had constriction of the breast with an implant that is wider than the base of your breast used to be.

I would definitely wait at least 6 or 8 months before considering revision, because it may not be necessary. The breast constriction will often stretch out with time. I think you will have a satisfactory result without further surgery. Good luck

Rodney A. Green, MD
Cleveland Plastic Surgeon
4.8 out of 5 stars 24 reviews

Double Bubble deformity after BA

I can imagine your disappointment with your breasts.  To me it seems that both breasts have double bubble deformities but that the left is greater than the right.  My preference would be to close the lower pockets and restore the fold.  This can be re-inforced with an acellular dermal matrix for a higher sucess rate.  They are expensive so be prepared.  The scoring your surgeon suggested is into the back of the breast, not the muscle.  They can help.  Putting the implants over the muscle will not help a great deal, but I would make sure the lower edge of the muscle has been released up to the level of the nipple to allow the greatest expansion of the lower poles of the breasts (dual plane).  A high profile implant is round and has a narrower base and more projection than either a moderate or moderate plus profile implant.  I can't imagine that any improvement the change would make would be worth the cost.

The pre-operative photo is hard to see, but it would seem that the lower inner quadrants of your breasts have constricted growth.  This is a mild form of a type I tuberous breast which is difficult to correct because it creates an unbalanced breast from side to side.  Implants are the same side to side.  It would seem that your surgeon may have lowered the fold more along the more medial aspect of the folds hoping the implants would fill the areas in.  This would explain why the double bubble deformity is greater in these areas.

Three months is the minimum amount of time I would wait.  I would prefer 4-6 months.  It is a difficult problem and you may want to get the opinion of another board certified plastic surgeon just to ease your mind.  Best of luck

Lori H. Saltz, MD
San Diego Plastic Surgeon
4.3 out of 5 stars 28 reviews

Breast implants and double bubbles

Your case is a difficult one because the before photo shows most of the breast tissue above the nipple level and I suspect the nipple to fold distance was less than is usual. That is probably why your surgeon lowered the folds. In that case jsut raising them back up is not the answer. In the after photos the double bubble appears to be solely in the inner half of each breast fold. Therefore I suspect the release was not sufficient to cover the entire bottom curve of the breast or was overdone in the inner halves of the curves. In such cases you also have to cut into the breast tissue in the lower half of the breast so that it descends and wraps around the lower half of the implant otherwise the lower edge of the implant will be lower than the lower edge of the breast tissue-hence the double bubble.

You will need corrective surgery to fix this with adjustment of the fold, possible reinforcement of the fold with dermal matrix and release/expansion of that lower breast tissue so it covers the implant.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

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.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

Double Bubble

One of the risks of lowering your inframammary fold is developing the double bubble, which it looks like you actually have on both sides.  After 4 months, it is fine to undergo a revision of this problem - you might look into using alloderm or strattice rather than scoring the muscle or subglandular implant which carries other risks with it.  Good luck!

Bivik Shah, MD
Columbus Plastic Surgeon
4.4 out of 5 stars 26 reviews

Implant malposition correction

Thank you for the question and for the pictures.

One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).

I see the  implant malposition that you are referring to  and agree that revisionary surgery will likely be necessary. I would also agree that it is too early and would wait approximately 6 to 9 months from now (at least). This will allow you and your surgeon to see the final results of the surgery and gives you the best chance of a single revisionary surgery achieving your goals.

Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. This is corrected by “raising” the inframammary fold using permanent internal sutures (capsulorrhaphy). This is done after careful measurements are made from the areola to the “new” inframammary fold.

Personally, I think  the capsulorrhaphy technique is your best option. There are many disadvantages to replacing implants in the sub glandular position.


Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,485 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.