Double Bubble 4 Months Post Op? (photo)

Question

I am 4 months post op. I noticed the folds, or edges of my implants at cleavage about a month ago. The double bubble look has been around for about 3 weeks. It looks better some days, worse others. I will see my surgeon soon but wanted other professional opinions. Is this correctable? With or without surgery?

Richard H. Tholen, MD, FACS · Answer

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!

Ryan Neinstein, MD, FRCSC · Answer

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

Kenneth Hughes, MD · Answer

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

W. Lorne Brown, MD · Answer

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

Tom J. Pousti, MD · Answer

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.

Steven Wallach, MD · Answer

Yes, it looks like you hav a double bubble more severe on one side than the other. Sometimes it stretches out to improve, and sometimes it does not. It can happen when the implants are larger than the base width of the breast or from over dissection, or from weakness of the chest.

Tal T. Roudner, MD, FACS · Answer

From your pictures it does appear that you have a double bubble on the left breast. You will have to have that surgically corrected with either a capsulorraphy (pocket correction with sutures or by creating a neo-pocket (new pocket over the old one to place the implant.

	Good luck

Thomas A. Narsete, MD (retired) · Answer

A double bubble occurs when the implant descends below the muscle with out support. There can be more than 1 reason. You should discuss this with your surgeon. Your circumstances can be improved with a revision. Best Wishes Dr Thomas Narsete Austin, Tx

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