Double Bubble or Implant Malposition?

Photo one week post op. IMF were lowered to make nipple placement correct. Saline 425 filled to 460cc. I'm 5'10, 150lbs. My left breast was a little larger due to the presence of milk. I was 2 months out from nursing on left side 4 months out on the right (it had stopped producing milk). What is going on and is it going to resolve? My PS said that everything looks great, but there is an obvious concern considering what my right "girl" looks like its to low and creating a double bubbl.

Doctor Answers 17

Double Bubble or Implant Malposition?

The posted photos are of help. The right "girl" has had a overly dissected inframammary fold release. This is not the double bubble but more poor attention to detail by the operative surgeon. You will need a repair. Sorry for your issues. 

Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Double bubble after augmentation

Thank you for the photos. Your preop photo shows that your breast crease on the left is lower than on the right. Unfortunately, your surgeon overdisected the fold on the right, causing your implant to drop, leaving you relatively empty superiorly as seen on your postop photo. You do have a double bubble and a lower right crease which is only correctable by surgery. Would wait at least 4 months.  

George Marosan, MD
Bellevue Plastic Surgeon
4.8 out of 5 stars 38 reviews

Double bubble

You indeed have what is called a double bubble deformity on the right.  Since you are only one week out I would wear a bra that can compress the double bubble on the right and hold the implant up.  It may not fix the problem and you would then need another operation.  However it might work since you are so early after surgery and could help prevent having to have another surgery.

Randy Proffitt, MD
Mobile Plastic Surgeon
4.6 out of 5 stars 23 reviews

Double bubble

You do have a problem with your implant position and the right fold.  This can be corrected with surgery to re-establish the fold.  Good luck!

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

Implant malposition, breast implant revision

It seems clear from your photo that the right implant is below the breast fold and you may notice as it is probably difficult to keep the bra under the implant on the right side. You can call it a double bubble, or malposition, though in any case the pocket will need revision and repair.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 43 reviews

Double bubble and bottoming out often go together

The 2 conditions are often related and the repair can be more complicated than it appears. It isn't the terminology that is important, it is understanding all of the causes, which include the muscle release that is a routine part of the typical technique for under muscle placement. (In general, bottoming out usually refers to settling of the implant over time, but with double bubble the bottom edge of the breast appears too low.) As I said yesterday in reply to your earlier post, these things typically do not improve on their own. Wish I had better news.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 54 reviews

Breast implant malposition/double-bubble

There are two types of double-bubble deformity. One is when the inframammary crease and the implant are at the proper level but there is inadequate release of the lower edge of the pectoralis muscle and it pulls on the lower breast and is transmitted to the skin. The other is when the inframammary crease level stretches or descends and the implant becomes malpositioned too low relative to the breast. Sometimes both can occur at the same time.

Your situation appears to be the second type and is clearly an operative problem as it occurred immediately although I keep patients in an elastic bra strap to hold the implant and inframammary crease in the first two weeks to make sure it is healed properly. 

I disagree that this is "over-aggressive" dissection of the inframammary crease. The crease level often needs to be adjusted down to accommodate a round implant if the distance from the nipple to the crease is short relative to the distance from the nipple to the medial border of the breast. What happened was loss of control of the inframammary crease level established at surgery. The best way to control this is to use an inframammary crease incision and suture the lower edge down to the chest wall and reinforce it with the bra strap for two weeks. The other probable cause is that the implant used was too wide to fit the width of your breast and therefore didn't stay where it was supposed to be. The left one went up a bit and the right one went down. 

Correction should wait to let the tissues recover, make sure the process is stable, make sure it doesn't happen on the left side late, and allow the tissues to adjust to the too wide implant. The simple correction of the inframammary crease level involves stripping out the capsule below the level of the inframammary crease level incision, oversewing/repairing the capsule and then suturing the skin below the crease level down to the chest wall with mattress sutures. This is again reinforced by a bra strap for two weeks. Consideration should be given to a narrower based implant as well. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Double bubble after augmentation

You do have a double bubble from over lowering the crease.  It will need most likely revision after you have healed for 3-4 months unfortunately. 

I can say that your situation is why I personally rarely lower the crease and would rather raise (lift) the breast to position the breast properly over the implant.  Your natural IM crease is the best barrier to implant descent and yours was lost in the surgery.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Double Bubble And An Implant Malposition

Hi Kay Girl,

You have both a double bubble and an implant malposition. This can be corrected but only surgically. It looks like your implant on the right breast has dropped. This is corrected by placing internal sutures to support the inferior breast crease. The double bubble is corrected by releasing the breast tissue so that it lies smoothly over the implant.

Best of Luck,
Dr. Franco-Webb

-Noticed this was posted three years ago, were you able to receive a successful breast revision? -Hope all is well.

Cecilia Franco-Webb, MD
Denver Plastic Surgeon
4.6 out of 5 stars 20 reviews

Implant malposition

Thank you for asking about your right breast implant position.

  1. The crease under the breast was fully released - so the breast implant has no support. Gravity pulled it down. 
  2. This is not an acceptable breast enlargement result.
  3. Your surgeon should correct this. If not, see another surgeon.
  4. I can often correct a disrupted mammary crease with local anesthesia in the office, but it is technically difficult. Many surgeons won't try it. Hope this helps. Best wishes.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 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.