Will a periareolar lift and some mild scoring/breadloafing be appropriate treatment for a revision surgery to fix double bubble?

Dear Imaginative382231,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Your photos show a significant degree of double bubble, and unfortunately it seems very unlikely that it will improve without surgical correction . You will need a capsulorrhaphy to re-set the inframammary fold back to its original position, and a breast lift. Make sure that the muscle isn't pulling where the crease is, which is animation deformity. That can also be a contributing cause.

I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question and photos. You have done your research and should be complimented for such. That said, your next best step is to consult with an experienced board certified plastic surgeon whose aesthetics align with your own and in whom you have confidence that he or she can help you. Only an examination in person can reveal the best specific recommendations for you.

The basic problem with a waterfall deformity is a mismatch between the encapsulated implant (usually too high) and a drooping breast that is sliding off the implant.

A subpectoral or dual plane implant position makes the likelihood of a waterfall deformity higher, not to mention the very unpleasant animation deformity that almost always accompanies a sub pectoral placement.

My own approach is a properly selected implant and a pocket conversion to subfascial (ABOVE the muscle) which re-establishes a more normal anatomy, and often allows you to avoid a mastopexy (breast lift).

Do your research with regard to finding a plastic surgeon, and focus less on the technical aspects of your treatment plan. That’s best left for your surgeon. Best of luck to you.

The pocket will need to be revised and possibly supported with mesh. I am not specifically aware of what your surgeon means by "breadloafing" since this is not a surgical term. The lift may not be needed once the pocket is corrected.

Dear Imaginative,
The anatomy of the inframammary fold is a very elusive structure. Subsequently, double bubble deformities do still occur. Interestingly, your preop Crisalix imaging anticipated somewhat of a double bubble result. So, I don't know that your fold should have been violated at all. Correction of a double bubble is also challenging, sometimes involving "bread loafing," sometimes involving reconstructing the fold internally, sometimes involving an implant plane change from submuscular to subglandular. Your surgeon should have an idea of what is best for your situation, having examined you and having been "in there." Good luck!