Planning Revision Surgery After Breast Augmentation - Need Help

I originally posted a question, "Can a lowered inframmary crease be corrected?" Many of you asked for pictures. I had my augmentation back in march of this year and my doctor has finally agreed to do a revision. The only thing that worries me, is that she seems a little unsure and admits to my case as being a challenge. We have discussed areola reduction, tissue release and removal to conform breast to implant, re-emphasizing fold, and larger implants. What would you do. I dislike my IMF :(

Doctor Answers 15

Re: "Double bubble deformity" - Revision of breast augmentation

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As noted by other respondents, you unfortunately have developed a classic “double bubble deformity” related to an inadequate release of the constricted inferior pole and with the submuscular placement and lowering related to the augmentation; the abnormal “double bubble” develops. Also the herniated retro areola breast tissue was not adequately addressed. Probably the best approach in your situation would be a periareolar incision, further release of inferior pole as much as possible, probably require a capsulorrhaphy to elevate the inframammary fold to make the “double bubble” less noticeable and gentle debulking of the retro areola tissue and a periareolar mastopexy. Your case is certainly a challenge but significant improvement can certainly be achieved.

Double bubble deformity after tuberous or constricted breast augmentaiton with implants

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I would agree with many other here in advising a circumareolar approach with areolar reduction, dual plane dissection with downsizing of implants, elevation of the inframammary fold, radial relaxing incisions, and possible neopectoral pocket or capsulorrhaphy and prolonged use of a supportive garment post-operatively.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Unhappy IMFs

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It appears that you may have had some constriction to your breasts prior to your surgery. I would suggest a periareolar approach with downsizing of your implants, reshaping the breast tissue internally and slightly reducing the size of your areola. I hope this helps. Dr ES

Revision Surgery for Breast Augmentation

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Thank you for your photos, these are immensely helpful. You have what appears to be a double bubble deformity but may in fact be an illusion given the previous constricted breast. If radial cuts in the breast tissue were not performed, this would explain the band across the lower pole of the breast. I would NOT recommend lowering the inframammary fold. For difficult cases such as these, I prefer a dual plane position of the implant and a supportive dermal matrix (Alloderm or Strattice) to support the implant and decrease the risk of eventual thinning of the expanded breast tissue in the lower pole. Areolar reduction may need to be delayed if a significant increase in implant size is to be performed. In my mind, tubular breast and constricted breast augmentation is much more of a reconstructive procedure of a congenital breast deformity. Controlling all of the factors (fold position, breast release, vascularity, nipple position, areolar size) in a single operation is what makes this a very challenging case. I recommend getting at least one second opinion when considering revision surgery.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Breast augmentation for tuberous breasts

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Thank you for the photos!  Very helpful.  Yes, you do have constricted breasts (also called tuberous breasts), which makes any correction challenging.  Here is how I would manage your case at this point:  circumareolar revision (scar around the areola to reduce the areolar size), release of the constricting bands inside the breast beneath the areola and in the lower pole of the breast, replace the same implants after suture reinforcement of the inframammary fold.  Fat grafting may be used later on for any remaining contour asymmetries.  Your surgeon is correct that your is a challenging situation, but I think you can definitely get a better result now.  Best wishes!

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 46 reviews

Revision of Breast Augmentation to Correct Tubular Shape and Double Bubble

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Hi there-

I'm sorry you did not get what you wanted...

It looks like you had a significant tubular or constricted breast shape prior to surgery, and that the lower pole was not adequately released. Combined with surgical lowering of your IMF and the fact that your nipple/areola herniation was not addressed, I agree you need a revision- these will not improve on their own.

I am never comfortable recommending details of the procedure without examining you, but think that important components of the procedure would involve release of the lower pole and addressing the nipples, and possibly reconstruction of your IMF

Good luck!

Classic Double Bubble Deformity from Constricted Breasts

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Dear Vophsi,

Your photos demonstrate a classic "double bubble" deformity from constricted breasts that were not properly released at the time of the first surgery.  The correction of constricted, or tuberous breasts also oftentimes involves reduction of the areolae.  Your folds may also require elevation, which brings another level of complexity to your case.  Good luck! 

Revision breast surgery requires special expertise

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The biggest predictor of the need for a revision with breast surgery is a previous revision; in other words, it is very difficult to get it right with a revision because they can be more complex than they seem. Analysis of the problem is particularly important. For example, the double bubble is typically attributed to a high inframammary fold, typical of the tubular breast, but this is not always the case. Your pictures show the constriction band going across the bottom edge of the areola, but I doubt that it was that high to begin with. It would be very helpful to know if you see upward pulling right at that level when you flex your pecs (animation deformity.) This is caused by the cut edge of the muscle healing into the implant capsule. Any attempt at correcting it without either converting to a split muscle technique or using an acellular graft such as Strattice will fail and put you on the path of multiple revisions.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Breast implants and double bubble

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I agree yours is a very difficult case. It looks like you started out with a mild variant of a tuberous breast with large areola and short nipple to inframammary creast distances. These mild tuberous breasts can be more difficult to deal with than more severe cases because sometimes the surgeon thinks they can get away with just augmenting the breast. As you have found out that does not always work. You will have to remove the implants, go back to square one, correct the tuberous breast and release the inferior constriction (barrel stave cuts, star shaped incision into the base of breast from underneath ....).Then the inframammary fold has to be repaired and then the implant can be replaced . This can all be done at one surgery but be very carefull choosing your surgeon you do not want to have a second revision if you can help it.

What you have now is the classic double bubble with disrupted inframammary creases.

Aaron Stone, MD
Los Angeles Plastic Surgeon

I would recommened pocket revision and not larger implants

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I would recommend bilateral implant removal and reattaching the infra mammary fold,fat injection and mastopexy. I would come back in 3 months for implant placement or more fat grafting depending on the size you desire. This is not the conventional treatment and most plastic surgeons would disagree.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 153 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.