I have a naturally occurring “double bubble” in my breasts. Is this common?

Question

I’m 18 years old and looking around with my mom for a BA surgeon in Miami, as nobody in my family has breasts so we’re certain they’re pretty much done growing, but I have this defect that seemingly nobody I know has. Is this common? Is this going to make it more difficult to complete a successful BA? I want to go small, around 225 cc, so it’s not like I want anything crazy anyways

Gary Lawton, MD, FACS · Answer

Double bubble can be fixed with transaxillary endoscopic breast augmentation because it is an operation where you can make cuts on the undersuface of the breast from the inside softening the infirmary fold.
The most sophisticated approach to breast augmentation is through the armpit with a surgical camera (transaxillary endoscopic). Using this modern approach the space can be crafted under direct vision, with virtually no bleeding and no postoperative bruising. Most importantly, the shape of the breast is meticulously created. The other, older methods of insertion are technologically less advanced. Both silicone and saline implants can be placed through the armpit by a surgeon with skill and experience using this approach. The incision in the crease is the oldest method of placing the implants and puts a scar directly on the breast.
  
A round implant would be a better choice because they move more like breasts. The anatomic implants have a textured surface which makes them feel very unnatural. In addition, there is no benefit to anatomical. There is an X-Ray study that shows the implants from the side at 6 months. Standing, the round and the antomical implants have the same profile. When you lie down however, the anatomical implants do not change, which is unnatural. A round implant will change when you lie down, like a natural breast would. 
  
HP implants, which are a more modern shape than moderate profile implants, fit most women better. They have a more appropriate base diameter and can be made to look very natural or very augmented, depending on where in the range the implants are filled to achieve a particular volume. High profile implants are the first choice in my opinion. I rarely find an indication to use moderate or moderate plus implants. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of volume, and where in the range the implant is filled.
  
There are many advantages to sub muscular dual plane placement and very many disadvantages to sub glandular placement.  I would see no indication to do anything but sub muscular dual plane.  Subglandular silicone implant placement is the historical approach to this surgery, and was widely used in the 1960's.  The implant edges are more visible, the risk of rippling is higher, the implant is in contact with the non-sterile breast tissue so the risk of infection and capsular contracture is higher.  The interface between the breast tissue and the muscle is blurred so the implant interferes with mammography more than sub muscular placement. Submuscular does not affect breast feeding. The blood supply surrounding the implant is worse so the risk of capsular contracture is higher.  The support for the implant is less so there is more long term shape abnormalities and sagging.  The look of a sub glandular implant is much less appealing than a sub muscular implant.  The placement of sub glandular implants makes any subsequent revision surgeries more complicated and less successful.  There are no advantages to sub glandular implant placement.
  
The choice between saline and silicone is one that requires a complex discussion of all of the advantages and disadvantages of both implants. The issues to be considered are safety, density, mobility, rippling, rupture rate, consequences of rupture, detection of rupture, need for follow-up care, cost of follow-up, appearance, feel, sensation of heaviness, radio-density, mammograms, and costs, among other things. There are advantages and disadvantages of both products. The decision will ultimately be up to you based on what is appropriate for your particular situation. Beautiful results can be obtained with either implant. 
  
The best way to determine the size that fits your personal perception of the perfect breast is to try on sizers. This way you can see how they fit on you, how they add to your current volume, and whether they fit your frame. Although the surgeon can guide you, only you will be able to tell what is the right size. Try on sizers. Measuring a diameter and then telling the patient what volume they can have (in high, moderate or moderate plus implants) in my mind is backwards. The patients should be allowed to choose the volume. Then the surgeon carefully considers the base diameter, projection, profile, manufacturer, and fill material that will achieve the patients goals of size as well as qualitative look (natural, intermediate, or bold upper pole fullness or projection), all the while taking into consideration the patient's anatomic features that will affect the outcome. The experience of the surgeon and the degree to which they explain the options to you is of utmost importance. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of implant. Don't let the doctor tell you what would look good on you. They cannot tell what you perceive to be the best size. There is no maximum. That is up to you.

Richard G. Schwartz, MD · Answer

Although unusual in a young woman, what your describe may be a variant of a tuberous breast deformity in which dense fibrous tissue and/or skin restricts the normal development of your breasts.  At the time of breast augmentation surgery, the surgeon can release these tight fibrous bands and spread out the breast tissue, creating a normally round shape overlying the implants.

Luis A. Mejia, MD · Answer

hello thank you for your question and provided information as well;..based in your question its not commun the double bubble , but is difficulted evaulate your case if the question dont have a picture, its recommended to get a consultation in personal with a plastic surgeon.

Zoran Potparic, MD · Answer

Without photos and/or in person examination, it may be difficult to answer your question. You may have a form of narrow base breasts or even tuberous breasts that will definitely need examination before surgery. You should schedule consultation with a board certified plastic surgeon with good reputation in breast surgery to discuss your goals and options. Good luck.

Urmen Desai, MD, MPH, FACS · Answer

The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with. Finally, make sure your surgeon is a Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Daniel Barrett, MD · Answer

Dear marcelagalofre,
it is hard to tell for sure without an examination or at least some photos. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Salih Onur Basat, MD, EBOPRAS · Answer

Hi and thanks for your question.
Generally double bubbles appearance is used for the separate movement of the breast tissue and breast implant. To precise evaluation , we need your photos. It’s to hard to say something without your photos.

Andrew P. Amunategui, MD · Answer

Hi Marcela and thanks for posting.  You may have a variation of breast skin constriction that give the breast a "non-smooth" contour as we have seen in other people.  You should be seen by your local BCPS with expertise in breast surgery.  Please see attached web reference/case 3.  Good luck!

Ram Kalus, MD, FACS · Answer

Technically, you cannot have a "double bubble" if you do not have a breast implant, and without an examination of photos it is difficult to discern what the actual anatomic concern happens to be. You may simply have a very glandular breast that is small, and if you are thin, the contour of your underlying breast gland may be visible. The other possibility is that you have a variant of chest wall anatomy with a protruding rib, which can also be very common. If you are not comfortable sharing photos, please seek out a board certified plastic surgeon whose photos on his or her gallery appeal to your own sense of aesthetics, and be sure to share photos of breasts that you find attractive or represent your concept of "ideal" such that your plastic surgeon can advise you on the best treatment plan for you. Breast augmentation is one of the most common cosmetic surgical procedures performed world wide and has a well over 95% patient satisfaction rating. In light of your age, according to FDA guidelines you are supposed to receive saline filled instead of silicone gel filled implants, but this is usually at the discretion of the patient and her plastic surgeon. One very popular choice in our own practice for the younger patient such as yourself has been the IDEAL Structured Saline Implant, the latest innovative FDA Approved breast implant to be made available in the United States with an excellent clinical record and extremely high patient satisfaction thus far. Do your research, and do not be afraid to seek out more than one opinion before scheduling your surgery. Best of luck to you.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  Unfortunately without a full series of pictures, or an in-person examination, it is difficult to offer advice on the best treatment option to you. I would recommend seeking out a series of ASPS board certified plastic surgeons in consultation to discuss.

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