Bottoming Out/double Bubble. Is It Something I Did or the PS Did to Cause Issue?

Had Bilat.Breast Aug. w/ smooth round silicone Natrelle 20-400cc implants, w/ bilat. crescent lift. Now 7 mo. post op, noticed bottoming out bilat. and double bubble R/L breast. Would love your expert opinion on how this may have happened so soon after surgery. Please help. Pre stats: wgt: 118, Breast size 34 B/C, hgt. 5"6, Tall/slender (Breast fed., volume loss and Lt. lower than Rt.) Post 34 DD Pic.'s were already submitted..not sure if you can view them, since I can't post them right now :)

Doctor Answers 6

Bottoming out?

Without at least photos I can not tell you if you have bottoming out. This can happen with implants that are too big for you, and/or if the implants  go below the natural breast fold.  This can be corrected.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews



It is impossible to give you advice without seeing you’re before and after pictures. You need to be examined and a lot of different factors go into giving advice in regards to what happened.



Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon
3.3 out of 5 stars 9 reviews

Bottoming Out/double Bubble

Without having photos to look at it is hard to offer advice.  Bottoming out is a term that refers to descent of the implant below the breast fold, causing the implant to lie in a lower position than was planned, and lifting the breast fold off the chest wall.

A double bubble occurs when there is a crease along the lower breast contour. There are several causes, including:

  • an impression of the original breast fold along the lower part of the implant
  • a visible compression caused by the lower edge of the pectoralis muscle
  • a sagging breast draping off the implant. 

In this setting, the first of the three is most likely. The cause is usually an implant that is too heavy for your tissues to support. This is not necessarily predictable, as some women tolerate implants twice the size of yours. I wouldn't say either that you or the plastic surgeon caused this issue. 

It can be fixed either using your own tissues to re-support the breast fold, or with the use of an acellular dermal matrix. The latter is quite pricey for the material, but is more reliable.

Thanks for your question, and I hope you will wind up with an excellent outcome. Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

#BottomingOut after #BreastAugmentation

Without photos, it is impossible to tell you more about the specifics of your situation. However, bottoming out and a double bubble deformity tend to go hand in hand. As the implant descends the implant crosses the fold of the breast and this creates a depression on the implant, and the "new" fold results at the bottom of the implant. These two creases combine to create a "double bubble" that often needs to be corrected with internal suturing of the breast pocket - sometimes called an internal bra.

You should see a board certified plastic surgeon in your area to get a formal opinion through and in-person consultation.

Best of luck,

Vincent Marin, MD
San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews

Bottoming out and double bubble

Sorry but saying much with out any photographs is hard to do. Please also note the shape of the implants that were used.

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 14 reviews

Concerns about Bottoming Out/Double Bubble after Breast Augmentation…

 I'm sorry to hear about the unsatisfactory result you have had after breast augmentation surgery. As you can imagine, without direct examination or viewing pictures it is difficult to give you precise advice. However, you should be aware that breast implants malposition problems, such as bottoming out, can present even at 7 months postoperatively.  Again, it is difficult to ascertain the cause of this issue in your case without much more detail, including physical examination.

However, you should have some peace of mind that these types of postoperative complications can be corrected with revisionary breast surgery, often using capsulorrhaphy techniques (internal suture reconstruction of the inframmammary fold/capsule).

 At some point, you may want to seek consultation with board-certified plastic surgeons who can demonstrate significant experience helping patients  in your situation.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 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.