I had my surgery on June 24, 2011. What Are my Options to Correct Double Bubble?

I had my surgery on June 24, 2011. I was a 34A and got 520cc silicone implants. However, at the 3 month mark I started to notice something was off. The incision was under the fold and my surgeon promised that it would not be noticeable, and that this was the only way to fit such a large silicone implant along with lowering my crease, so i trusted him. I now have double bubble and my breast stay raised up in the air, always exposing my incisions. Its been 18 months. What are my options?

Doctor Answers 15

Double bubble after large breast augmentation

Your photos do seem to indicate that you have developed a double bubble and bottoming out after large volume breast augmentation. I do feel that this can be corrected surgically, either with the use of an acellular dermal matrix product (Strattice, Flex HD, Alloderm) or without. Both scenarios involve a return to the operating room and supporting stitches in the inframammary region  in order to correct the bottoming out and reverse the double bubble changes. The use of the acellular dermal matrix provides a bit of an insurance plan that the corrections can be made and long lasting, but it is not imperative that you use ADM. Downsizing your implant is a consideration that might also assist in long lasting correction of this problem.

Saint Petersburg Plastic Surgeon
4.9 out of 5 stars 32 reviews

Double Bubble and Correction?

 Thank you for the question and picture.

I think you are correct,  in that your breast implants have displaced inferiorly ( bottomed out).

Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. This is corrected by “raising” the inframammary fold using internal sutures. This is done after careful measurements are made from the areola to the “new” inframammary fold.

Correction of the bottoming out may help “hide” the existing inframammary incisions as well.

I would suggest in person consultation with plastic surgeons who can demonstrate significant experience with this type of surgery.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,503 reviews

What Are my Options to Correct Double Bubble?

I usually try to fix this first by fixating sutures at the bottom and then have patients avoid bouncing or pressure for 6 weeks and wear an underwire bra non-stop. If this does not work I may then go to Strattice, but because of the cost of the product I usually don't go to that as my first choice unless the patient is willing to use it...

John J. Corey, MD
Phoenix Plastic Surgeon
4.6 out of 5 stars 45 reviews

Double bubble after breast augmentation

This defect is caused by over dissection of the inferior pocket and needs to be corrected.  The inferior fold needs to be recreated and supported, possibly (but not necessarily) with the use of a biologic membrane support.

Ask your surgeon about his/her experience with this type of revision.  If you are not confident then find a board certified plastic surgeon who knows how to correct this.

Daniel Greenwald, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 46 reviews

Double bubble

The fold can be raised back up, you may want to consider smaller implants. Some would consider using Strattice for additional support but it is fairly expensive.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Double bubble

Thank you for your question.  You indeed have a double bubble deformity with bottoming out.  You had very large implants placed and besides the suture repairs and possibly Strattice placed like other surgeons reccomended, I think you do need to seriously discuss reducing the size of your implants with your surgeon as part of the potential treatment plan.  Good luck.

Vishnu Rumalla, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 201 reviews

Double bubble and bottoming out

Your photographs show both a double-bubble deformity and bottoming out. The breast implants appear to have migrated below the original inframammary folds, recruiting abdominal skin onto the breasts and becoming visible below the breasts. In general, repair would involve an inferior capsulorraphy (sutures placed at the bottom of the scar tissue envelope that forms around the breast implants) to raise the pockets. The so-called acellular dermal matrices (like Strattice and Alloderm) are sterilized dermis (skin) from various sources. They may be used in cases such as yours, but I generally feel that they are only needed in more severe cases than yours.

Of course, to determine the specific surgical plan and possible outcomes, you must have a formal consultation with a board certified plastic surgeon familiar with breast revision surgery. Thanks for your question.

Steven Goldman, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 151 reviews

Bottomed out implants

Your implants have settled a little too low and this is called bottoming out.  It looks like a repair with sutures could fix the problem but requires an experienced surgeon for the best chance of success.  Others might use Strattice for a stronger repair but personally I would only use that on you if a suture repair failed.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Double bubble on breast augmentation

I do agree with you that you probably have a double bubble deformity to the breasta, although this is difficult to fully tell about without seeing you in person for an exam.  This would be the direct result of going too big with the implant many times.  It is certainly correctable, but you may have to decrease the size of the implants slightly, as well as to properly anchor the incision under the breasts so that the scar is directly at the bottom of the breast fold.


Good luck with your future efforts to correct this if you are advised such by your Plastic Surgeon.  Always ask your original Plastic Surgeon for help in gaining a better result for you.


Frank Rieger M.D.  Tampa Plastic Surgeon

Double bubble after breast augmentation

You indeed appear to have a double bubble deformity.  The size of the implant may have contributed to the development of the problem; it may also limit the effectiveness of any repair.

Recreating the breast fold (inframammary fold) with internal sutures is a typical first approach to address this issue.  Patients never want to hear this, but you may have to consider using smaller implants to put less weight and stress on the repair.

Ask your surgeon what can be done.  Seek a second opinion, if necessary, but make sure that whoever you chose to address this has experience with this repair.  Best of luck.

Michael S. Hopkins, MD (retired)
Albuquerque Plastic Surgeon
4.9 out of 5 stars 83 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.