Bottoming Out/double Bubble? What Would You Do? (photo)

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 right breast. Want revision asap. Please see photos...would love your expert opinion on what's going on with my breasts and what options I may have in correcting this. What would you do in this case? 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 D

Doctor Answers 10

Bottoming out and double bubble after breast implants - solutions

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Bottoming out happens when your breast tissues can't hold the weight of the breast implants. The implants descend as the skin and breast tissue stretch. The "double bubble" happens when the implant slides below the old breast crease and the old crease leaves an indentation across the breast. One way to approach bottoming out and a double bubble is to raise the position of the implant by reattaching the skin to the chest to reestablish the old breast crease. This is done with internal stitches. This can work, but the problem is that the tissues may stretch again. One way to strengthen the repair is to add an internal sling to help support the implant. Biological meshes like Strattice can work well for this. Unfortunately, Strattice is very expensive. The added cost may save you money, however, by reducing revision risk in the future. 


I hope this helps! Best wishes.


Michael Vennemeyer, MD

Bottoming Out/double Bubble? What Would You Do

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There are 4 options. 1st Live with it though you do not want to. 2nd Revise the muscle insertion. 3rd place implant above the muscle. 4th fat grafts to dented areas. Or a combination of the operations 


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Thank you for your pictures, it looks like you have a double bubble that with time it can be improved. In our practice we have our patients wear a breast band to help the fold. It’s your old fold you are seeing and the skin needs to stretch out.


Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

Correction of “Bottoming Out/Double Bubble” after Breast Augmentation?

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Thank you for the question and pictures.

I think you may benefit from revisionary breast surgery;  as you can imagine, precise advice will necessitate direct examination. Most likely, you will benefit from “reconstruction” of the inframammary fold areas using internal suture techniques (capsulorraphy).  These internal sutures will help prevent the breast implants from displacing and should correct the appearance of the "double bubble" ( created by the prominence of breast tissue  sitting over the lower breast implant).

Seek consultation with well experienced board-certified plastic surgeons; ask to see lots of examples of their work helping patients in your situation.

Best wishes.

Bottoming out or double bubble

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You have many options including doing nothing at all. I see adouble bubble on the left side and bottoming out on both. The implants may need to be repositioned with a alloderm or other form of sling for reinforcement.

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon

Correction of implant malposition and double bubble

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Implant malposition  is often corrected with internal suturing and or capsulorrhaphy.

consideration may be given to a smaller implant to change the base diameter.

the use of an internal graft such as belladerm may be needed.


you may just try taping the fold for a few month to see if this will reposition the implant



Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Fold malposition correctio

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Agree with your assessment. Sometimes these malposition terms get confusing- double bobble, bottoming out, fold malposition etc. in essence your fold became disrupted and the implant fell. Correction involves correcting the fold - sometimes using a tissue support like Strattice. Start with your original surgeon for a consultation and seek other advice if they are not helpful.

Jason Pozner, MD
Boca Raton Plastic Surgeon
4.7 out of 5 stars 46 reviews

Bottoming Out/double Bubble? What Would You Do? (photo)

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Notwithstanding my esteemed colleagues recommendation, and your desire for improvement, there are multiple complex reasons for your "double bubble."  Still, it is only visible from certain angles and most visible with your arms elevated, and it is not as prominent as others I've seen.  The problem results from your pre surgical breast anatomy, chest wall dimensions, and FDA imposed limitations on sizes and shapes of implants available to American women.  My first choice to correct this problem would be extremely careful fat grafting along the lower edge of implant to camouflage it.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

Bottoming out

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From your photos it looks like your implant has descended below the desired position and you do have bottoming out on this side.  I do not think external support will solve your problem and that you will need revisional surgery to elevate the fold with internal capsulorraphy sutures.

Leonard T. Yu, MD
Maui Plastic Surgeon

Bottoming Out/double Bubble?

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Other than the option you have excluded, which is no treatment, the other choice is surgery to reef up the breast fold.

There are two groups of operations to do this. One uses your own tissue, one uses a product:---

  • Using your own tissues, sutures are placed to create the breast fold-(inframammary fold). The upside is there is no foreign tissue. The downside is that your own tissue has already failed.
  • Using acellular dermal matrix, usually a product known as Strattice. This is a biologic product used to support the implant and the fold, which is gradually replaced by your own tissue that grows into the matrix. Upside is high success rate. Downside is expense of the product and cost of extra operating time to insert it.

Discuss all possibilities with your surgeon. Thanks for your question and for the excellent photos. Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.