Double bubble - silicone over the muscle. Should I go under the muscle? 1 1/2 year post BA. (photos)

Thank you for your question. Please follow up with your plastic surgeon about your concerns. Regards, 

Mr224.  Breast Augmentation revision can be complicated and best advice given after thorough examination.  Not sure if you have double bubble of animation deformity, but in either case revision should be done on both sides for better symmetry.  Even though you are thin, placement of silicone implants over the muscle should not be a problem.  Thoroughly discuss your options with your plastic surgeon.  Good luck!

Hi Mr2244,

Thank you for the question and the photos. I understand your concern. Based on your photos, it appears that you have developed bottoming out of your implants.

Bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.

Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.

If you are concerned, please check it with your plastic surgeon. This way, your plastic surgeon can discuss further the best approach to resolve your concern.

Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery 

Member, Am. Society of Plastic Surgery

Sorry fr the severe animation deformity with double bubble effect plus asymmetry. Only in person examination waked allow a determination of exact operations o offer in this scenario. 

As you said, you have a double bubble and breast implant bottoming appearance after your revision surgery. A double bubble is a cosmetically unfortunate condition for patients with breast implant, which happens when the breast neglects to go up against the state of the implant, bringing about the presence of a noticeable line demonstrating a partition between the base edge of the implant and the base edge of the normal breast. double bubble deformations might be all the more obvious when breast implant have bottomed out. Please follow up with your surgeon.Best of luck!

Thank you for your question.  Based on photos alone, you definitely have a double bubble on the one side. This occurs by violating the inframammary fold.  Changing the implant position from under to above the muscle will not correct this deformity. To correct  the double bubble your inframammary fold has to be re-created with a Ryan flap. This is done by anchoring the fold to the fascia of your chest wall. 

I am sorry to hear about your concerns after breast augmentation surgery. 
As you state, 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. 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.
 
Best wishes.

While this can absolutely be improved, you would do best to have a thorough consultation with a plastic surgeon experienced in both revisional breast surgery and doing so in fitness athletes. My experience with competitive bodybuilders/fitness competitors has shown that there is a rather wide variation in priorities such as muscle deformity vs rippling vs palpability vs cost etc.In addition, there are several options for recreating the proper inframammary fold with very different considerations.

Thank you for your question regarding your post op result. The condition you demonstrated is a bottoming out of your implant below the infra mammary cease, and below the margin of your pectoral muscle. This can be due to a large implant placed behind the pectoral muscle, or a breakdown of the muscle attatchment to your chest wall. I would suggest you go back to your surgeon and discuss your options. One solution is to repair the muscle, and place your implants above the muscle on both sides. Once this is corrected, you should notice an immediate improvement...Dr T Narsete...Denver, Co