Is this “Double Bubble”? Will a revision be needed? (Photos)

Dear MinnieMoo25,


though rare, some women who undergo breast augmentation will develop a minor deformity known as a “double bubble,” in which additional folds appear underneath the breasts due to the implant accidentally shifting or contracting post-surgery. In most cases, the implant simply slipped too far down the chest wall and traveled behind the breast inframammary crease (the area where the lower breast meets the chest), instead of moving forward to fill the breast cavity. If left untreated, the lopsided implant will form unnatural indentations, resulting in an odd “four-breast effect” rather than the full, rounded chest the patient initially desired.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

This would require a complex breast revisionary surgery including pocket work, Galaflex, new implants and a lift. You likely needed a breast lift at the time of the original implant placement based on the apparent nipple to-fold-distances. When the skin is stretched over time (gravity/breast feeding etc), the nipple-to-fold distances get too long...this is what creates the deflated look or nipple malposition compared to the breast mound. In your particular case, it appears that the right breast implant has bottomed out over time. You can see the original breast fold above the now lower right breast fold that was stretched out by the implant over time. I would recommend seeing an expert in revisionary aesthetic plastic surgery.

If you decide to go for a revision, consider an internal bra. It doesn't look like your tissue is providing a lot of support for the implants, which can contribute to a double bubble. An internal bra will give a more stable result.

By your photos it does appear that you have a double bubble on the right side. The procedure would be to perform a capsulorrhaphhy inferiorly +/- placement of mesh for added support. You may leave this alone as your breast look good when you hands are by your side. The thing about revision surgery is that there are risks involved where you could come out worse than you were before, for example developing capsular contracture after the procedure.
I would discuss this further with your surgeon or get a second opinion in person with a board certified plastic surgeon that performs a great deal of revision surgery.

Dear MinnieMoo25,
Thanks for posting you before and after pictures, though it would have been helpful to have pictures without nipple cover, before picture of side view and after pictures with arms down. In any event, from the posted pictures the following is noticed: 1. Wide cleavage and upper pole capsule contracture. 2. Asymmetrical right breast sub mammary crease. It is lower than left crease and has double bubble deformity The corrective procedure are medial and superior capsulotomy (scar release) and right breast inferior Capsulorrhaphy (internal bra).
Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, nice projection, nice upper pole slope, symmetrical and natural looking.
Best of luck,
Dr Widder
widderplasticsurgery.com

Your implant is bottoming out and the inferior pocket can be corrected. Please do not go larger. Go back to your surgeon and discuss your concerns.