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

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

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.

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).

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.

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.