January 2011:1.BA 550cc HP submuscular, resulted in dubble bubble, muscle flex distortion and capsular contractur. May 2011: Explant. October 2011: 2.BA 550cc subglandular to fix previous problems. Now my left crease sits lower than the right one, creating a tiny double bubble and making breasts uneven. PS suggests lowering right crease and cutting off excessive skin (leaving a big scar)! Surely I must have other choices? Could a larger implant fill out the skin more and erase the DB? Hugs Marie
Are there Any Other Choices to Fix Double Bubble Other than Lowering Crease? (photo)
Doctor Answers 13
Double Bubble Correction with Too Large Implants
After reviewing your photographs Marie, you appear to be young and have already undergone 3 breast surgeries and now about to undergo your 4th. From your most recent photograph with the 550cc silicone implants, your breasts look inappropriately large for your frame. Also, since the implants are subglandular, there is nothing supporting them other than the skin envelope. In the coming years, your breasts are going to droop and you will need ANOTHER operation. My advice to you is go with smaller implants now . If you keep the large implants and do dermal matrix or other internal support techniques, it is most likely that you will need another revision (5th operation). Your body is telling you that those implants are too large and won't be stable long term.
Gary Horndeski, M.D.
Small Double Bubble Treatment Options In Breast Augmentation
Given the small size of your double bubble, you may be better off to leave it alone and just live with it. While the excision choice is one treatment approach, a 'non-scar' option would be to downsize your implants and suture back down the fold internally which has been expanded due to the size of the implants. Your choices for correction, as you can see, are not likely that appealing and the problem at this point may be better than the solutions.
Are there Any Other Choices to Fix Double Bubble Other than Lowering Crease?
I am sorry to hear about the complication you have experienced. The double bubble phenomenon usually represents a problem along the lower pole of the breasts, where one can feel/see the breast implant below the “previous” infra mammary fold area. One “bubble” is caused by the breast implant, the other by the breast tissue.
Reconstruction will likely involve the use of sutures to repair the breast implant capsule and reconstruct the inframammary fold areas. The use of additional supporting material such as acellular dermal matrix or biosynthetic mesh may be helpful also.
Make sure that your plastic surgeon has significant/demonstrable experience helping patients with this type of revisionary breast surgery. You may find the attached link helpful to you as you learn more. Best wishes.
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Tight IMF crease
You have a tight pre-existing IMF crease, which creates the "double bubble" look. There is one other non-surgical option you could try: fill the area of the crease with careful use of fillers, such as Sculptra. This would help build that area up, reducing the indentation - much like using a filler to improve a wrinkle or crease on the face. Fat grafting to the area could also work.
Do not use a larger implant - that will make the problem worse.
Best of luck!
Double-bubble and revisional breast surgery
This is a complex issue and there is no simple answer although the various responses posted have aspects of it. In my opinion and experience, the original double-bubble was caused by too big (wide) an implant and inadequate release of the pectoralis muscle in the lower pole of the left breast. This problem would normally be solved by changing from a subpectoral position to a subglandular position of the implant even if the implant is still too big and wide to fit properly behind the breast, but in this case the residual double-bubble is caused by the inadequate release of the old capsule which doesn't allow the implant to fill out the lower pole properly. There may even still be some muscle pull distortion. The simplest solution to keep the existing implants would be to use an inframammary incision, temporarily take the implant out, control the level of the inframammary crease, and release the entire new and old capsule of the left lower pole, and put the implant back in. This would likely result in a left breast that looks like the right one. I doubt that the dermal matrix graft would be needed for this. A slightly narrower and less projecting implant would help but that would require changing both implants. A return to subpectoral positioning would also help make a more natural looking breast but at this point that would be even more complex than changing both implants and releasing the left lower pole.
I believe a accellular dermal matrix would help with the double bubble and not require lowering the fold. It would also give more support to help prevent bottoming out. Donald R. Nunn MD Atlanta Plastic Surgeon.
Maybe another option - composite breast augmentation
Ultimately what you are trying to achieve is two breasts that look the same. From your before picture (though the angle is not ideal) it appears there was some difference in shape between the breasts to start with in that the fold on the left is more angled than the right. In your after pictures your natural fold on the left is clearly more angled laterally than the rightIf you are otherwise happy with the size of your breasts and the breasts are otherwise soft and stable, I would consider a completely different approach, composite or hybrid breast augmentation. This involves selective fat grafting to the areas of concern to achieve symmetry and balance of the breasts. One can definitely improve the double bubble appearance and the fold asymmetry with selective fat grafting, particularly in the area where your natural fold steps off from the fold created by the implant pocket. Symmetry in all dimensions may be impossible to achieve in all dimensions with implants alone. Remember, implants are not custom shaped, so if there is a difference in shape (not just size) of the breasts, it may be impossible to get perfect symmetry with implants alone. I would definitely avoid larger implants as this can compound the problem as the tissues are unable to support the weight of the implants over time.
More complex solutions like Stratice may work, but will never completely address asymmetries if they already exist in your own breasts. The other beauty of fat grafting is no open surgery or large incisions are required.
Capsule Repair with Strattice
Every plastic surgeon who has commented makes a valid point - however, I am going to agree with Dr. Baxter that if you want to keep your size and subglandular position the best bet is to repair the fold/capsule and support with Strattice. We have going on 3 year data with Strattice for this issue and the results seem to hold up. Please note that i consult and am a speaker for Lifecell - the makers of Strattice and Alloderm.
Double bubble needs elevation of crease
The left crease needs to be elevated internaly by reattaching the area of the double bubble to the chest wall. there eill be no external incisions.