Concern with risk of double bubble breast aug (Photo)

At breast aug consult dr assured that I did not need a lift (put a ruler under breast to confirm nipples are not below fold), but warned that I "may see the old creases" due to being size B already (?) but that it would resolve in 3 mo. I have another appointment for sizing before surgery, but want to make sure he's not saying I'm going to have double bubble to avoid doing a lift? Confused. Please take a look at photo and provide input if possible. I lost 45 lbs 5 yr ago, loss of volume/droopy

Doctor Answers 6

Concerned about possible double bubble with breast augmentation.

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Congratulations on your weight loss and keeping it off! Your breasts do show moderate grade 2 ptosis, but the assessment that you do not need a lift appears to be correct (though, of course, I do not have the benefit of a physical exam or measurements). Perhaps the mention of a possible double bubble has caused an elevated concern (reasonable--I'd have a similar response), but I don't think that should change the assessment or the advice regarding a lift NOT being necessary.

No surgeon can guarantee in advance just how much an individual patient's implants will drop as healing, softening, and settling occurs, and EVERY (honest) plastic surgeon has had and will occasionally have double bubbles. Usually they resolve (sometimes in weeks, sometimes in months, and sometimes incompletely), but if they are severe, bothersome, or persistent, surgery CAN usually correct or at least significantly improve the concern.

Truly, there are many other issues to be equally or more concerned about, so choosing your plastic surgeon is the most important issue here. None of us has received our "perfection" badge (yet--my mom says mine is coming, but then again, she also says modesty is my only fault), so listen well and ask plenty of questions. Please also read my Comprehensive Guide to Breast Augmentation by clicking on the web reference link below. Best wishes! Dr. Tholen

Double bubble

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Double bubble is usually when a patient has a short distance from the nipple to the fold of the breast. Then if they have a larger implant, and the fold needs to be lowered to fit the implant, and the skin does not stretch a double bubble forms. It is the old breast crease being tight over the new implant with a new lower fold.

Usually droop does not lead to a double bubble except with a very short fold. Droop can lead to a "snoopy dog" deformity with the breast tissue hanging over the implant. 

Severe cases of droop require a lift. Less severe cases of droop may be helped by subfascial placement of the implant, a shaped teardrop implant, a mini peri areolar lift, or a larger size implant.

Concern with risk of double bubble breast augmentation

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Thank you for your question. The problem you have is that your breasts are low. The lower part of your breasts fall well below the lower edge of the muscle where we usually place implants. Your surgeon will need to cut the muscle to allow the implant to lie directly behind your breasts to avoid the 'double bubble' look, but by cutting the muscle - he weakens the only support mechanism available to keep the implants in place. Cutting the muscle allows the implant to become displaced after time. If you are ok with having corrective surgery to move the implants back into place, then move forward with this plan. Placing the implant in front of the muscle poses the same problem. There is nothing keeping the implants in place. By not lifting your breasts, your breasts will appear larger but in the same low position, with the risk of becoming lower as time goes by. If you are happy with the volume, a breast lift can reposition and reshape your breasts higher on your chest wall giving you natural cleavage. I have attached an example of a woman who just wanted her breasts back where they were when she was younger. She did not want the risks and complications associated with implants. Please take a look at my gallery to find women with similar dimensions as yours to see what can now be achieved with current breast lifting technology. Vertical incisions are no longer necessary with this method. I hope this helps.

Best wishes and kind regards,

Concern with risk of double bubble breast aug

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Of course examining you in person would be a more accurate way to give advice but based on the single photograph and your description of your nipple position I would give you the option of either a conservative breast augmentation without an uplift or, a Benelli uplift to raise your nipple position so they are more centered on your new breast implants.  In some cases I have the patient's permission to make a decision between the two procedures depending upon how the implant settles at the time of surgery when I select the size and position.  I think it is rather important to emphasize avoidance of a double bubble rather than correction of it and it becomes necessary to minimize the undermining below the natural inframammary crease when trying to create a pocket for the implant hoping to give the illusion that your nipple was higher.  Using the "dual plane" technique a Benelli mastopexy MAY be avoidable as well.  Enjoy the video above for additional information that you will find interesting.  Good luck and best wishes,

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

Concern with risk of double bubble breast aug

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If your nipples are above your fold, you don't need to undergo a lift. Double bubble deformity can happen but is more common in women with a tight fold or those who have received implants too large for their pocket. At my practice, we utilize a series of 5 breast measurements that help me determine the ideal implant size, which in turn helps me deliver a 24 hour recovery. Do your research and choose a surgeon who takes the time to sit down with you and discuss your goals/expectations to determine the correct size for you. Good luck!!

Concern with risk of double bubble.

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The risk of double bubble, where the implant extends out under the breast, is higher in those with a tight and high breast fold, a narrow breast diameter, and an implant too large for the breast skin envelope. The B cup, with supple skin we feel tends to lessen the risk if the implant is wisely chosen.

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.