How to Fix Extreme Case of Double Bubble/bottoming out with over Dissected Pockets? (photo)

Went from 34B to 32D with transaaxillary 375cc mod plus silicone implants. 5'6" 125 lbs. Noticed pocket was too big right away and at first was concerned about double bubble appearance. Noticed bottoming out and extreme muscle distortion soon after. I am at 2.5 months. How can this be fixed in a way that won't interfere with breastfeeding in the future?

Doctor Answers 8

How to fix double bubble

Thank you for posting photos.  Yes, you can correct this complication with a capsulorrhaphy which is internal suturing to tack up your fold.  That should also help your nipples move back to a more central location on your breast mound.  It's a fairly simple procedure but just be sure to consult with your surgeon and discuss your options so you can come up with a plan together.  Best of luck! ac

Newport Beach Plastic Surgeon
5.0 out of 5 stars 5 reviews

Best Way To Correct A Double Bubble Is A Capsulopexy!

A capsulopexy is a way of using the scar tissue or capsule around an implant to elevate the bottom of a breast that has been over dissected.  Over the past 30 years, I have performed over 100 capsulopexies.  I have used every published technique and a few that I invented myself.  Some work great, some not so great. 

I have found certain techniques absolutely essential:

1.  A periareolar incision (incision at the lower edge of the areola) gives the best visualization and the least chance of failure.

2.  Obliteration of that portion of the capsule below the new desired bottom of the breast.   Merely suturing this area (capsulorraphy) allows for secondary ptosis (implant falling back into the over dissected space). 

3.  Suturing capsule wall tissue to rib periosteum to elevate floor of implant pocket.

4.  Use of acellular dermal matrix (ADM) if capsule is thin or if implant is large.  ADM is sutured to rib periosteum and skin using balloon sutures.  This is done in conjunction with inferior capsular repositioning.

5.  Use of Reston Foam under breasts to help lock in position of newly created inframammary crease.

Obliterating a double bubble through an inframammary incision (below the breast) assumes one knows where the crease is going to end up, and it is very difficult to place an implant in the breast pocket and then close it from below.  Also, capsulopexies done through an inframammary incision look very harsh and abnormal as compared to a periareolar capsulopexy.  

The size and weight of the implant has little to do with the success of this procedure as long as correct surgical techniques are used and a 24/7 underwire is worn for a minimum of 90 days post op.     


Violation of the infra mammary fold creates a double bubble will

Infra mammary fold is been violated on both sides will. I would suggest you remove the implants and let the fold reestablished itself. Delayed reinsertion into a properly position pocket should give you a good result.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

How to Fix Extreme Case of Double Bubble/bottoming out with over Dissected Pockets?

In your case you appear very athletic build in the before posted photo. I might have offered over placement with fat grafts (if you had some donor areas of fat for lipo). Now I would remove the implants and either allow 3 months of healing. Or re insert above the muscle in a very tightly dissected pocket, close the infra mammary fold on the right. Best to obtain ONLY in person opinions in this very difficult case. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

How to Fix Extreme Case of Double Bubble/bottoming out with over Dissected Pockets?

I am sorry to hear/see the complication you have experience. The good news is that revisionary surgery can be quite successful in improving your situation. This operation will likely involve “adjustment” of the breast implant pockets using internal suture techniques ( capsulorraphy).  Essentially, the breast implant pockets are changed in shape and volume, preventing the breast implants from migrating;  currently they seem to be displacing inferiorly and medially.  Doing so will also improve the position of the nipple/areola complexes on the breast mounds.

 I would suggest that you make sure that your plastic surgeon has significant experience with revisionary breast surgery.  You may find the attached link helpful to you as you learn more.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,498 reviews

Double bubble deformity.

I would recommended bilateral inferior capsulorrhapy and repositioning of inframammary to its original position using permament braided sutures. This includes removal of the capsule below the inframammary fold and closing the anterior and posterior capsule.  I would also reinforce this with acellular dermal matrix or similar material.  I would perform a superior capsulotomy to create space for the implant to move up.  I would approach this through a inframammary incision most commonly, but a periareolar  incision is also an option.  The implant size is probably okay but often I suggest going to smaller implant.  Finally, postoperatively, I recommend a surgical bra 24/7 for 6 weeks.  Good luck. 

Perry J. Johnson, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 18 reviews

Breast Augmentation revision with Strattice

The crease that is causing the double bubble is the old inframammary fold before implant placement and over-dissection of the pocket.  The solution is repair of the capsule (capsulorraphy) to raise the implants back up to the level of the old inframammary fold.  The problem is that it is difficult to get the repair to hold with the weight of the implant on it.

The solution is to reinforce the repair of the pocket with Acellular Dermal Matrix (ADM).  The best substance for this is Strattice, made by LifeCell Corporation.  It may also a good idea to replace your implants with something slightly smaller, although this is not mandatory.

Fat transfer, breast enlargement

You might want to consider bilateral fat transfer to correct the appearance of the breast along with implant repositioning on the right.  Fat transfer will give you a modest liposuction benefit and allow sculpting of the breast which is difficult with implants.  Good luck.

Ralph W. Bashioum, MD
Minneapolis Plastic Surgeon
4.2 out of 5 stars 17 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.