Double Bubble 4 Months Post Op? (photo)

Sorry, but double bubble is one of those things that occurs in certain patients with certain anatomy. It may be more common with some anatomic conditions such as short inframammary crease-to-nipple distance, in very thin patients with dense and clearly-visible breast tissue "edges," in patients who request large implant sizes, and in cases of surgical over-dissection or patient excessive-dropping.

Over-dissection sounds like a surgical "error," but we never know in advance just how much softening, settling, and scar stretching will occur in any given patient, even with years of experience and thousands of breast augmentation cases.

Your last photo depicts activation distortion, another type of post-surgical concern, but one that can certainly occur with or without double bubble issues. It is clear that your pectoralis fibers were released inferiorly (as they should be), but now that your pocket has softened and healed (and swelling has gone down) to a great extent, those cut muscle fibers have healed to the breast capsule, causing it to visibly deform when the muscle is contracted. Activation distortion is entirely different from double bubble, but they look similar to one another.

I would first wait at least 6 months (12 months is better, or at least until your scars have completely faded--this is a reliable indicator that your internal capsule has done the same degree of maturation) before considering re-operation. Your lower breast tissues may stretch and obscure the double bubble appearance to a large degree. If not (or not enough), you and your surgeon can then decide what should be done surgically.

Surgical correction depends on the degree of the problem at that time, but usually invloves internal capsulorrhaphy to tighten the capsule and raise the pocket slightly. Sometimes use of capsular flaps or ADMs (acellular dermal matrices) helps. These surgical corrections are usually successful, so do not despair. Stay in close contact with your surgeon--this is not his/her "fault," nor is it yours. Best wishes!

The real question you have to ask yourself here is are you ok with these results or not, if these are acceptable to you I would not suggest having another operation that can cause more issues

   There are a couple of things to consider here.  First, this double bubble is a little more subtle than most, and this may not be as noticeable with time.  Of course, a surgeon can correct the pocket.  If your pocket is corrected,  you may need a breast lift due to the new lower areolar position, and this could be determined by looking at your preoperative photos.  Find the plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast augmentation revisions each year.  Kenneth Hughes, MD Los Angeles, CA

It would be interesting to see your pre op photos.  In  some situations the distance between your nipple and your inframammary fold is short relative to the size of implant.  In these cases we like to score or make a series of incisions on the inside of the breast to allow the lower pole of the breast to relax.  Given that you had a late onset to the problem, as well as that fact that it waxes and wanes,  I would wait.  The person to give you the best advice is your surgeon

I'm sorry to see/hear about the concerns you have after breast surgery. You are correct in that you are experiencing a breast implant displacement/malposition problem. Unfortunately, these types of breast implant displacement/malposition issues cannot be “corrected”  non-surgically. Revisionary surgery will likely involve the use of internal sutures ( capsulorrhaphy)  and/or the use of acellular dermal matrix to help prevent the breast implant from continuing to “displace”.  You may find the attached link helpful to you as you learn about the procedures available.

 Best wishes.