Double bubble, or bottoming out? Should I fix it or deal with it? (Photos)

6 months post op, 405 and 375 cc silicone round moderate profile.I noticed the crease on my left breast when lifting my arms up. I made an appointment with my surgeon and he simply said it wasn't that bad and he would not recommend a correction surgery. Now, two months later I am noticing the deformity in both breast without lifting my arms up andwhen I flex my pectoral muscles.Should I just live with it like the dr. Suggests or consider correction? And if so, what is the average cost?

Doctor Answers 1

Double bubble, or bottoming out?

I am sorry to hear about your concerns after breast augmentation surgery. 

It looks like you have "double bubble" and breast implant bottoming appearance after your revisionary surgery. 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. Your case, the appearances exaggerated when you are flexing ( "animation deformity").


There are several options when it comes to revisionary surgery to improve your outcome.  One option is to eliminate the pull of the pectorals major muscle either by completely releasing it or by suturing the muscle back down, thereby placing the breast implants  in the sub glandular position.  Patients who choose to have breast implants placed in the sub  glandular position should have enough breast tissue coverage to allow for this conversion. There are disadvantages of placing breast implants in the sub glandular position (such as increased risk of breast implant encapsulation) which should be considered as you make your decisions.

Another maneuver that may be helpful is raising the inframammary fold using capsulorraphy techniques. Sometimes, depending on factors such as quality of skin along the lower breast poles, additional support provided by acellular dermal matrix or biosynthetic mesh may be very helpful. I have also found the use of acellular dermal matrix very helpful in cases where the skin/tissues are very thin and in cases of recurrent breast implant displacement. The acellular dermal matrix helps improve contour, improves irregularities caused by the underlying breast implant and/or scar tissue, and provides additional support ("sling" effect) for the breast implants.

 Whether or not to undergo revisionary breast surgery will ultimately be a personal decision that only you can make after carefully weighing the pros/cons associated with additional surgery. Essentially, the decision will come down to  weighing your level of concern with the current situation against  the downsides associated with additional surgery ( risks, time off work, additional expenses…).

When it comes to cost of surgery, there may be many “variables” involved. The specific surgeon's credentials/experience level (or lack thereof), the specific geographic area you are looking at, the different operations available, the location of the procedure ( quality of surgery facility), type/quality of anesthesia provider, type of breast implants… are some of the potential variables involved. You will find average costs of surgery listed on this website, and on individual plastic surgeon's websites as well

I hope this, and the attached link/video, helps.

Best wishes.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.