Have my implants bottomed out or formed a double bubble? (photos)

My initial surgery was in Oct by board certified Dr. I have developed pec muscles and I hated the big animation deformity I have. After talking to my doctor I thought my problem was called rippling and that it could be solved if I swapped to silicone. So in Dec I had my 2nd op. The deformity is worse now (I now know the only way to solve that is subglandular placement?) But also when I am relaxed my breasts are misshapen with ripples in the bottom. They are not hard. What's going on?

Doctor Answers 10

Silicone implants do not solve animation of submuscular breast augmentation.

Silicone implants have lower risk of rippling than saline, but they do NOT solve animation problems with submuscular breast augmentation.  Further release of the muscle may help improve animation problems. Switching to a subglandular (on top of muscle) implant definitely solves the animation issue, but I personally think that you are giving up several benefits the submuscular placement gives you in order to solve a problem that can be solved differently and still preserve the benefits of keeping the implants submuscular.

The middle photograph shows a breast contour that reminds me of a constricted breast that wasn't identified and corrected at the time of the initial surgery. The only way to know for sure is to actually examine your breast (preferably prior to your initial surgery) and evaluate for the typical signs of constricted breasts.


Salt Lake City Plastic Surgeon
4.9 out of 5 stars 249 reviews

Revision

It looks like you are going to need a revision for fold reconstruction.  The surgery may require placement of  a biological mesh. 

Bottoming out

Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.
Bottoming out and Side Boobs Contributing Factors:
  1. Larger/Heavier Implants
  2. Implants placed above the pectoralis muscle
  3. Chronically not wearing a bra when upright
  4. Over dissection of the Implant Pocket
  5. Smooth Implants
  6. Large swings of weight including pregnancy
  7. Skin and soft tissue laxity, loss of elasticity

Inframammary crease reconstruction

Your photos show exactly why I advocate preserving the breast crease in an many cases as possible. You will need a revision to repair the crease and tack it back down to the chest wall. Please seek the top expert in your region as this is not as easy as just putting in implants.

Revision

It is possible that your implants are dropping.  Photos alone can not tell the whole story.  I would see your surgeon to confirm and work out a solution. 

Dr Rodger Shortt
Oakville Plastic Surgeon
Assistant Clinical Professor &
Director of Cosmetic Surgery Training,
McMaster University

Rodger Shortt, FRCSC
Toronto Plastic Surgeon
5.0 out of 5 stars 52 reviews

Bottoming Out / Double Bubble?

Good evening!

You do have a significant amount of bottoming out, and the correct repair is the Internal Bra, my strong permanent internal suturing technique which lifts and supports your implants position. It is the most common type of revision I perform, 5-6 times a week- it works and it lasts!

You also have quite a wide gap and very little upper pole fullness which will be addressed during your correction.

I have attached a link to my Bottoming Out / Internal Bra / Breast Augmentation Revision photo gallery for your review- hope it helps!

Double bubble

Thanks for the photo's , yes, it looks like your implant bottomed out due to inframammary crease weakness.  Your PS would have to surgically revise and recreate a new crease.

Chad Robbins, MD
Nashville Plastic Surgeon
5.0 out of 5 stars 36 reviews

Breast augmentation - am I bottoming out

Thank you for asking about your breast augmentation.

  • I am so very sorry you have had such a problem with your breast implants.
  • Your photos certainly suggest that your implant may be bottoming out -
  • This is usually from weakening of the infra-mammary crease - so the implant slides low on the chest.
  • Whether the implant is above or below the muscle, fixing a double bubble requires recreating  the normal bresat crease.


Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Double bubble

 Sorry to hear about your unsatisfactory result after secondary breast augmentation surgery. From the photographs you have supplied, it does appear to me that you have a "double bubble". In my experience, this has never necessitated switching an implant to the sub glandular plane. There have been multiple procedures described to remake the infra-mammary crease and some will include the use of in acellular dermal matrix like Strattice. The thickness of the matrix will also help support the breast and be an added bulk to cover any wrinkles that you might see at the bottom. Discuss the options with your plastic surgeon and I would recommend getting a few opinions from different plastic surgeons in your community. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

Have my implants bottomed out or formed a double bubble?

I am sorry to hear about your concerns after breast augmentation surgery. 
It looks like you have "double bubble" and breast implant bottoming appearance after your revisionary surgery. A "double bubble" is a cosmetically undesirable circumstance for patients with breast implants, which occurs when the breast fails to take on the shape of the implant, resulting in the appearance of a visible line showing a separation between the bottom edge of the implant and the bottom edge of the natural breast.   Double bubble "deformities" may be more striking (visible) when breast implants have bottomed out.
 
There are several options when it comes to revisionary surgery to improve your outcome.  One option is to eliminate the pull of the pectorals major muscle either by completely releasing it or by suturing the muscle back down, thereby placing the breast implants  in the sub glandular position.  Patients who choose to have breast implants placed in the sub  glandular position should have enough breast tissue coverage to allow for this conversion. There are disadvantages of placing breast implants in the sub glandular position (such as increased risk of breast implant encapsulation) which should be considered as you make your decisions.

Another maneuver that may be helpful is raising the inframammary fold using capsulorraphy techniques. Sometimes, depending on factors such as quality of skin along the lower breast poles, additional support provided by acellular dermal matrix or biosynthetic mesh may be very helpful. I have also found the use of acellular dermal matrix very helpful in cases where the skin/tissues are very thin and in cases of recurrent breast implant displacement. The acellular dermal matrix helps improve contour, improves irregularities caused by the underlying breast implant and/or scar tissue, and provides additional support ("sling" effect) for the breast implants.
I hope this, and the attached link, helps.
Best wishes.

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.