Best options for fixing double bubble? (photos)

Question

11 months since surgery. I do not want to reduce implant size or have fat grafting . Will a breast uplift create lots of new scars? I'm already unhappy with the right scar being visible . I've always said the surgeon cut me to low down on the right boob my rib is painful and it's agony to wear a bra. My left boob is ok . Would a bigger implant going over the muscle be any good ? As I currently don't like this size.

Don W. Griffin, MD · Answer

With double bubble, the implant pocket is below the natural fold of the breast. To correct double bubble, the implant pocket needs to be closed on the bottom to elevate the fold back to the level of the natural breast fold. This can be done with internal sutures to tighten the pocket. Often, these repairs are reinforced with mesh or acellular dermal matrix to try to prevent the pocket from reopening due to the weight of the implant and downward force of the pectoral muscle. Additionally, a capsulotomy is sometimes done to open the breast pocket in the upper breast to decrease the downward force on the implant.

Bradley A. Hubbard, MD · Answer

I am sorry for your trouble with this surgery. The implant is too low on your body and a double bubble has formed. The pain is due to the bra pinching the skin and implant on your chest wall. Both the cosmetic issue and pain would likely improve by moving the implant up. This can be done in three ways:1. Creation of a new implant space (above muscle). Doesn't work well in your situation because the lower part of your implant space  is above the muscle anyway. This is best for symmastia. 2. Tightening your implant space at the bottom with stitches and making more room at the top.  50-80% success rate. Depends how strong your capsules are and how well your body forms scar tissue to support the implant against gravity. 3. Tighten your implant space at the bottom and reinforce the repair with synthetic dissolving mesh (galaflex, 500$) or biologic mesh (strattice, 1400$). I think both work equally well with 99% success rate. Best of luck! See before and after examples at link attached.

Vasdev Rai, MD · Answer

Option # 1.   Take right implant out. Close double bubble pocket. Put implant back in.  Rib pain will remainOption # 2. Take both implants out. Retire submuscular pocket. Put larger implants in front of muscle. Rib pain will go away and you will look more natural.

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast augmentation surgery. It looks like you have "double bubble" and breast implant bottoming appearance. 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. In my practice, this type of repair involves a two layer, permanent suture repair (reconstructing the inframammary fold areas). This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation.

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.

Tania Medina de Garcia, MD · Answer

Hello dear, thanks for your question and provided information as well..I recommend you to go to your board certified plastic urgeon for a revision, you need other implant type, the same silicone  but better for you and that can help your implants to not move out of the pocket, also you need  a lift to get rid of that extra skin you have

Best options for fixing double bubble? (photos)

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