Animation deformity, double bubble or bottoming out? (photos)

Question

I had my breast augmentation 8 weeks ago. Ergonomics round Motiva 295 cc. I started to notice a bump on the under side of the two breasts, but especially the right( I am right handed). What is it? Shall I fix it somehow? Will an elastic band over the upper pole help, or it will make things worse?

Richard H. Tholen, MD, FACS · Answer

Animation deformity occurs when the pectoralis muscles contract and distort the smooth round appearance  of the lower poles of the breasts in women with submuscular implants. Every submuscular augmentation patient exhibits some degree of breast shape change with muscular activity, but it is severe and bothersome to a truly small minority of patients. Submammary (above the muscle) implant placement removes this deformity, but increases the likelihood of an even worse deformity--capsular contracture. Thus, most surgeons choose the lesser of two potential evils by going below the muscles and performing careful selective release of the inferomedial pectoralis major muscle fibers. Though your photos do not show active movement, the presence of the slight contour distortion (bulge) below the level of your pre-operative infra-mammary creases indicates this is a minimal double bubble deformity. It would not be incorrect to also describe this as slight bottoming out, since you are only two months post-op, and time, gravity, and further tissue stretching will probably worsen this to a degree. An elastic band will make things worse. A supportive bra and time for the old crease areas to stretch further (without lowering your new creases further) will minimize ongoing deformity. If the double bubble worsens or persists to a degree you find unsatisfactory after healing is complete (6-12 months), treatment may consist of secondary surgery to tighten the internal pockets inferiorly and raise your new creases as required to diminish this appearance. If things stay as they are right now (no further dropping, and stretch of the lower poles to diminish the old crease visibility), I'd say you have an excellent result, and the very slight contour irregularity will be so mild that no one will be able to see but you or someone looking carefully at comparison photographs. After all, no partner will be examining your breasts with calipers and measuring tape! They are beautifully distracting and a fabulous improvement from your pre-op deflation.Follow your surgeon's instructions, and do nothing for 6-12 months so you are not trying to "fix" a problem that has not yet declared its final position and degree of visibility. Be patient and realize that each patient is her own worst critic--no one else will look as closely as you! Best wishes! Dr. Tholen

Yannis Alexandrides, MD, FACS · Answer

It's difficult to determine the root cause of a problem without seeing you in person, but it's quite possibly a double bubble. It could be helped by wearing an elastic band on the upper pole of your breast which is something you would need to ask your surgeon about.

Richard Baxter, MD · Answer

There are 2 causes of double bubble: One is when the bottom edge of the breast is lowered, leaving a groove across the bottom of the breast where the original fold was, and the other related to muscle activity/animation. Because the pectoral muscle is partly detached with the dual plane method, it adheres to the capsule as it forms around the implant, which can cause a groove that looks the same as double bubble. You can determine if this is the cause by observing if the groove pulls upward when you tighten your pec. This does not usually improve with time or strapping, etc. If that is what is going on, then consider converting to the split muscle plane (numerous examples on my website).

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs. Though nothing replaces an in-person examination it appears that you may have a subtle case of bottoming out.  This is causing the delineation between your breast tissue and implant along the lower portion of your breasts.  I would allow your results at least six months time to mature and then revisit your appearance.  If unacceptable a revision procedure can be performed to improve upon your outcome.  Hope this helps.

Christopher V. Pelletiere, MD · Answer

Based on your pictures, you certainly are seeing a delineation between your breast tissue itself and the implant.  Whether this is a true double bubble or not is hard to say.  Massaging the breasts may help a little, but an upper pole band will not help anything.  Give it a full three months of healing, and if it is still noticeable at that time then I would address this with your surgeon or go for a second opinion.  I hope this helps.

Vaishali B. Doolabh, MD, FACS · Answer

Hi.  Hard to tell for sure without a physical examination, but its unlikely to be animation deformity (need to see effect of pectoralis contraction to know) or bottoming out.  The indentation of your native inframammary fold (where the breast meets the tummy) can lead to a scalloped contour, with the bottom fullness being the implant itself.  Talk to your PS, and be sure to give this a little more time as it may resolve on its own-if not, you may consider a revision to help loosen/release the fibrous attachments of the native fold.  A band is not indicated. Best wishes,

Robert M. Tornambe, MD · Answer

I appreciate your concern, however physical examination would be helpful because it is difficult to tell from the photos that you submitted. It does appear simply be the lower edge of the implant and as you continue to recover, this should subside as the implants settle in. Follow up with your plastic surgeon for further advice. Best of luck.

John W. Menard, MD · Answer

With time this may work itself out. I would give this a few months to see if it persist. If it does, the implant may need to  be elevated. I would give this a few months then see your surgeon if it continues.

Eric YK Li, MD · Answer

Based on the photos, your surgeon likely lowered your natural inframammary fold to create a pocket to fit your implants.  The bump you are seeing is therefore your old inframammary fold, and the problem you are facing is a "double bubble".  The old inframammary fold features tight bands of tissue which need to be released during surgery for the lower pole to round out.  In some circumstances even despite release it remains a tight area that needs to stretch out over time.  If it does not, then revision surgery is always possible to try to further release the tissues.  At this point, I recommend waiting 3-6 months to see your final shape, it may go away on its own.  Hope this helps!

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast augmentation surgery.  Although it is still too early to evaluate the long-term outcome of the procedure performed, your concerns are understandable. Your plastic surgeon will be your best resource when it comes to accurate assessment but, based on the photographs, I think you are likely dealing with a "double bubble" concern.
The “double bubble” appearance that you are noticing is related to the breast implants that are inferiorly position. 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. If this remains a concern in the longer term, repair is possible using internal sutures (capsulorraphy). This procedure will serve to reconstruct the inframammary fold area, correcting the implant malposition and improving the contour (double bubble effect).
Best wishes.

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