So, in looking at your photos it appears that the two sides are very different. Your didn't mention anything about this but it can have some important implications. One implant looks much higher and no double bubble is evident. On the other side the implant is much lower and you have an obvious double bubble. Looking carefully at the DB side it is evident that you had a very tight elevated inframammary fold and the distance from your nipple to the chest wall was quite short. This situation makes an augmentation challenging. If the implant is placed so that it is no lower than your existing fold, then the implant will look quite high and your nipple will rotate downwards (as in you non-DB side). On the other hand, if the implant is placed (or descends) below the level of the fold so it is centered behind your nipple, then the nipple will point straight ahead, but you are then at risk for getting a double bubble. There are ways to manage this problem through modification of the skin and lower pole breast tissues but in patients with extremely tight inframammary folds it can be difficult to completely eliminate the suggestion of a DB. A third alternative can be do a breast lift to lengthen the distance from nipple to fold but that requires additional scars on your breast - not a solution most women would prefer.
Flexion or animation deformity is a potential problem whenever an implant is placed under the muscle, although for the vast majority of patients it is rarely a major problem. Unfortunately for dancers it can be far more noticeable. The problem of flexion deformity is worse with saline implants, smooth surface implants, and larger implants. It is also dependent on your specific muscle anatomy. In patients with a high fold the muscle is usually oriented so that greater release of the muscle is required to properly position the implant and this can predispose you to more severe flexion deformity. I would assume that the flexion deformity is worse on the side with the DB. Your surgeon should have discussed of these issues with you before the surgery so that you understood the challenges and potential tradeoffs. You photos show that you went with a quite a large implant for your frame, but that significantly raised your risks of having these problems.
Putting the implant on top of the muscle can solve the flexion deformity problem but with a large implant you will end up with significant thinning of your tissues which will put you at risk of palpable/visible implant and visible rippling over time. Probably the simplest solution for you would be to raise the implant on the DB side so it matched the other side without the DB and consider switching to a textured surface highly cohesive gel implant which will help reduce the flexion deformity. The other alternative would be to consider the split muscle technique but that may be difficult with a large implant.
From your photos, it appears that the double bubble crease needs extensive release and probably consider repositioning of the implant to the submammary plane from the sub pectoral plane. This has been helpful in my practice when such discrepancy is a problem.
I do many revisions fortunately not too many on my patients and it can be corrected by switching to on top of the muscle. You should be able to help the problems you are having with my neopocket of placement.
Yes one of your options is to switch from submuscular to subglandular position of the implants. Any good breast surgeon certified by American Board of Plastic Surgeons should be able to do that. I have done this on a couple of instances for the same reason and it solves the problem. I would recommend you have form stable silicone implants for this. You don't have a lot of soft tissue coverage and a saline implant will probably show ripples.
I understand your concerns, and it is a common one that when implants are placed under the pectoralis muscle, there sometimes is a "double bubble" deformity, and the breasts move unnaturally with muscle movement. I agree (and have published) that changing the implants from under the muscle to above the muscle frequently solves this problem.
Hello,It appears your breasts were different in appearance from each other before surgery, with one with a higher inframammary crease and tighter tissue envelope. That is why one has a double bubble and the other doesn't but instead has suboptimal nipple position. Changing to a subglandular position may or may not help, but you can expect new problems like rippling and implant palpability. If your surgeon isn't a ABPS certified/ASAPS member surgeon who specializes in revision breast surgery, you should seek out a second opinion with a few who are.Best of luck!
Only your one side (with your arm down in photo... Let's call it the right) has a double bubble. That's because your implant is lower on that side. If you want the bubble gone, your surgeon needs to bring the pocket together at the bottom, called a capsulorrhaphy. Then both breasts can look like the left. If you hate your muscle flex deformity, you can fix your pec and have the implants moved, which has some disadvantages as well, such as implant visibility and greater risk of capsular contracture.
Thank you for the question and photos and the implants can be easily switched if that is what you desire. So go on some complimentary consultations with experts in the area and be evaluated
Hello and thank you for your question. I prefer to keep implants under the muscle as a) the breasts look more natural and b) decreases your chance for long-term problems like capsular contracture. If the animation deformity is too bothersome to you, it is ok to place the implants on top of the muscle as long as you understand the above disadvantages. Most importantly, I think fixing the double bubble is important and doable at this point in time. Please make sure to seek consultation with a board certified plastic surgeon with expertise in aesthetic breast revision surgery. I hope this helps!Sincerely,
Dr. Sean Kelishadi
You are demonstrating a double bubble deformity which is created when the inframammary crease is released to accommodate an implant that is larger than what your breasts can accommodate. What you should have done is either a breast lift to get your nipples higher to accommodate a larger implant or had a smaller implant placed that would fit on your breasts without having to release your inframammary crease;