22, 440cc, Motiva, smooth round, extra high, is this a double bubble deformity? How can it be fixed? (Photos)

Dear samxxbot,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Maybe. It looks like a bit too much distance and skin excess between nipple and medial inframammary fold. The way the implant hangs in the loose skin allows the folding or deformation of the implant shell that is causing this appearance. This might be improved by tightening up the capsule in that area and taking up some of the slack.
However, we are not being shown an animation view, with flexion of the pectoralis muscles. There is the possibility that the surgeon over-released the pectoralis too high on its medial insertion on the sternum. That is a different situation and harder to correct and would likely need some kind of mesh or ADM to close off that space.
An in-person exam with a board-certified plastic surgeon would be needed to tease out these subtleties.

You either don't live in NY, and live outside the US, or you went to another country; Motiva are not available yet in the US. Regardless, you have double bubble and that faint shadow is your old inframammary fold. It can't be fixed with a surgery and will require a capsulorrhaphy, preferably with mesh to help improve the durability of the results.

Your implants are beginning to bottom out from the weight. I would suggest going smaller and tightening the lower pocket. You might even need mesh for support. This happens when tissue does not support the weight of the implants. To prevent it from becoming worse, always wear good supporting bras.

You appear to have a very slight double bubble which is caused by the old breast crease It can only be fixed with surgery, however, yours is so small I wouldn’t suggest doing anything with it. If you wait for several more months, it may improve on its own.

This is a double bubble deformity seen with submuscular implant placement
Consider placement above the muscle ,or re attachment od the muscle

Nicely posted photos, To respond to each question: A. No, only some surgical option can improve this; B. You have a slight "double bubble" deformity. It is the inferior edge of the pectoralis muscle when at rest or in flexion causes the breast tissue below this edge of muscle to indent. This can happen in this position of the implant. Might consider "dual plane" position. C.(3.) Only surgery... Best to virtual consult with....

You have an exceedingly subtle double bubble where the old IM crease is indenting the breast above the new crease. This probably came from lowering the crease to fit in the large implants. No fix without surgery but yours is so small you should let it alone for a year to see if it doesn't stretch out to satisfsaction. Discuss with your surgeon.