Will my Double Bubble Be a Difficult Fix? (photo)

Question

Last year I had a breast aug. (325cc hp silicone implants) The 1st day after removing the bandages I noticed a distinct line across my left breast. Needless to say, I am very dissapointed with my results. I am have gotten a few different opinions on how to fix this and I'm just not sure anymore what my best solution is. Is it still possible for me to have normal looking breasts??

Robert W. Kessler, MD, FACS · Answer

You can certainly have normal looking breasts after the repair. This will require restoring the fold of the breast to its previous position using internal sutures. Revision surgery is more difficult than the primary procedure and there is always the possibility of needing additional surgery though the incidence of this is low. Seek out a board certified plastic surgeon with experience in revisional breast surgery. I hope this is helpful.

Ali Sajjadian, MD, FACS · Answer

HELLO AND THANKS FOR THE QUESTION AND PICTURES.EVENTHOUGH DOUBLE BUBBLE CAN BE DIFFICULT TO FIX AT TIMES, MAJORITY OF TIMES, IT CAN BE FIXED IF YOUR SURGEON IS EXPERIENCED IN REPAIRING OF THECAPSULE AND CREATING INTERNAL BRA. THIS IS DONE BY SUTURING AND HOLDING OF THE IMPLANT WHILE RE-CREATING NATURAL ANATOMY. YOU COULD ASK FOR PICTURES OF PATIENTS WITH SIMILAR FINDINGS.HOPE THIS WAS HELPFUL.DR SAJJADIANDrSajjadian.com

Vincent N. Zubowicz, MD · Answer

Violation of the infra mammary fold at the time of breast augmentation should be avoided. When the implant falls below the fold a double bubble deformity can occur. This is difficult to fix.

Boris M. Ackerman, MD · Answer

The so called "double bubble "deformity can occur when the implants are placed below the natural breast fold.  Placing the implants below the fold should be undertaken with great caution.  In some cases it can be done successfully with nice results, in some others in leads to an obvious deformity.  An experienced and talented surgeon can make that determination.  

	 

	Correcting the double bubble deformity can be done successfully with a few different techniques. In some cases, depending on the size the shape of the breast that patient desires, the use of ADM (acellular dermal matrix) such as Strattice or Alloderm could be required.  Make sure that you seek out a surgeon with significant experience correcting this deformity.

Ronald J. Edelson, MD · Answer

The double bubble can be fixed with internal suturing of the inframammary crease. This is a tricky procedure to get right, however, and you should make sure the surgeon who does the revision is experienced at the procedure. The use of a dermal matrix should not be necessary and increases the cost of the procedure substantially.

Kevin Brenner, MD, FACS · Answer

Repairing a problem like the "double bubble deformity" is definitely possible. Usually it involves repair of the inframammary fold. Some patients also benefit from placement of an acellular dermal matrix graft such as Alloderm to help reinforce the fold position.

Kenneth Hughes, MD · Answer

Your breasts can be fixed by suturing the pockets closed and supporting the implants in a higher position. You could consider dermal matrices, but this increases the cost significantly. Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast augmentation revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA

Amy T. Bandy, DO, FACS · Answer

Hi Carol, you do not mention if your implants are in front or behind the muscle. I agree with the other posts, that a capsulorraphy is the procedure of choice, but if the implants are in front of the muscle, then switching them to behind the muscle will be helpful to give more support to the infra-mammary fold. Another option is to add a dermal matrix, like strattice, to add additional tissue for support. Without an exam, it is difficult to say whether that would be necessary or cost effective for you, as the cost of the dermal matrix is quite pricey. The surgery to correct the double bubble is more involved than a simple implant exchange, however in the right hands, can accomplish a beautiful result. Be sure that the doctor you choose is experienced in this procedure and can show you photos and or patient references. Good luck!

Richard Baxter, MD · Answer

Since you noticed the double bubble right after surgery it is most likely due to lowering the fold in order to accommodate the diameter of the implants. If the diameter is too large then correcting the problem by internal sutures (capsulorrhaphy) may not be successful in the long term. Another issue to be aware of is the relationship of animation deformity to double bubble; if there is "windowshading" or pulling upward of the crease with contraction of the pectoral muscle, then this also will not be corrected by internal sutures. Conversion to the split muscle plane is best in that situation.

Gerald Minniti, MD, FACS · Answer

Hello,

	Yes, sewing the pocket closed is an excellent technique for closing down the pocket, as the very experienced Drs. Pousti and Kessler have mentioned.  Just for the sake of completeness, there is another method that works just as well, called making a 'neo-submuscular pocket'.  This involves carefully separating the scar capsule (which defines the limits of the implant pocket) from the undersurface of the muscle, but only to the limit of where it is necessary, and not past that point, which would be your original inframammary fold. The implant is removed and replaced on top of the capsule after it has been sewn closed to itself, so the implant sits between the muscle and the old capsule and is therefore still below the muscle. 

	I use either technique, but feel that the neo-submuscular pocket is more reliable for pocket adjustments that involve the side of the breast nearest the sternum.  Regardless, either should not be performed by surgeons not familiar with subtle nuances of revision surgery.  If your original surgeon is not experienced with a good reputation for revision surgery, you would do yourself a favor and consult with those that are.  Certification with the ABPS is a baseline requirement, but still does not indicate a commitment to aesthetic surgery.  Membership with the ASAPS is very important as it indicates such.

	With a well executed revision surgery, you should have a very nice result!

	Best of luck!

Will my Double Bubble Be a Difficult Fix? (photo)

Answers (16)

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