Is my Right Breast Bottoming out or Showing a Double-bubble Deformity? How Did This Happen? (photo)

I am 5 months post-op. I recieved 450cc high profile silicone gel implants, placed submuscular with incisions in the breast crease. Almost immediately I noticed that the right nipple sat higher, which I hoped would improve as the left breast decended, but more recently I have noticed my old breast crease becoming more evident on the right and the implant sitting lower than the one on the left. I notice a bit of a "double-bubble" appearance, especially in a pic. How can this be fixed? So sad!

Doctor Answers 7


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There are a number of conditions that are collectively called "double bubble." As the term implies, there are two contours visible, where only one is desired. I think of three separate conditions:

  • Patient needing a lift who did not have one, resulting in the native breast tissue sagging off the breast implant, creating two contours. 
  • Lower margin of the pectoralis muscle creating an impression on the implant causing two contours
  • The original breast fold causing an impression on than implant which is positioned lower than the fold. 

Without being able to see a pre-op photo, I would hesitate to guess as to which of the latter two conditions this represents. It is not a case of having needed a breast lift. At an in person exam your surgeon should be able to tell. 

Sometimes these creases stretch out with time and become less noticeable or unnoticeable if the implants are otherwise symmetric. I do suspect that a revision surgery will be needed to correct this.

Thanks for your question and for the attached photos. Best wishes.

Seattle Plastic Surgeon


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It looks like the fold will have to be corrected on the right breast. It can happen and it is fixable. See your plastic surgeon.

Double bubble

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It sure looks like you have a double bubble. This happens when the implant migrates below the fold and can happen when the implant base is signifcantly larger than the overlying gland expecialy when the gland has a narrow base.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast Implant bottoming out.

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Hi Erica - very sorry that you have concerns about your right breast, which shows a form of double bubble deformity.  This has been caused by too much release of the fold on the right and will need repair of the fold.  The size and projection of your implants have lifted the fold off of your chest wall.  Discuss this with your surgeon - good luck

Is my Right Breast Bottoming out or Showing a Double-bubble Deformity? How Did This Happen?

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Yes I see the minor imperfections you are writing about. I might try fat grafting to even out these issues before having a more aggressive surgery. 

Double Bubble Deformity

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Hello Erica,

I am sorry you are having these issues.  Of Dr Gottlieb's description of the various potential double bubbles that occur, yours is the last.  He didn't explain it quite right though, it is actually the native inframammary fold that has lifted off the chest wall.  The upper bubble is your breast tissue and implant, the lower bubble is just your implant. This is the most common type that is seen in women with your pre-operative appearance (lean body, small breast, high inframammary fold) who also receive large and/or high profile implants.

50% of my practice is revision surgery and I've never seen double bubble deformity improve.  If is very subtle, usually the patient 'get's used to it'.  If it is severe, it usually worsens with time until reaching some stable endpoint, as the implant continues to stretch the thin chest skin that is now covering it. Although it looks like a 'dent', it is not, and therefore will not soften or stretch into a smooth contour. You will need a revision surgery that will close off the lower part of your pockets (there is a subtle double bubble on the left side too).  Durability of repair is enhanced if smaller implants are replaced.  This surgery will improve the nipple position as well.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Bottomed out breast implant

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Your photo shows what looks like a bottomed out breast implant as the primary problem.  The indent along the bottom is the old crease denting the implant above the new crease where the implant has settled.  This could be called a double-bubble.  The basic problem though is bottoming out and this will only correct with surgery.  Sorry for your troubles.

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