Potential for Double Bubble - is There Anything I Can Do? (photo)

Have been to several breast augmentation consults - and was told that I have less below the breast skin then normal (I guess the skin between my nipple and chest)...and therefore may have a higher risk for double-bubble complications. Is there anything I can do to lessen this? Would a smaller implant prevent this? I breastfed two young children and just do not have a lot of breast tissue left. I am deciding between 371cc mods (12.9) or 450cc hp (12.4)...silicone. I am shooting for a full C.

Doctor Answers 15

Breast augmentation in patients with a tight lower breast pole

When patients have a tight lower pole a periareolar approach is often best.  This approach allows for "radial scoring" of the lower breast tissue.  This means that the tissue from the inside can be released by cutting through the bands like spokes on a wheel.  The breast fold can be left undisturbed in addition.  That combination allows for expansion of the lower pole of the breast.  There are limitations as to how large a patient can go with that technique.  If the areola is small then silicone implants may not be possible and likewise is the areaol is very small then this approach may not work at all.  Based on the pictures a modest implant volume throught a periareolar approach would likely work best.  A large implant through an incision in the fold may not allow for proper lower pole expansion.  I hope this helps.  Best of luck!

Cleveland Plastic Surgeon
5.0 out of 5 stars 126 reviews

Risk for Double Bubble

   Any time the distance from the nipple areola complex to the IMF is short your IMF can be released to some extent.  The key here is to sequentially reduce this without removing all of the connective tissue present.  It takes a plastic surgeon with ELITE CREDENTIALS who has done this hundreds and hundreds of times to know how to get away with this without creating the double bubble.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Double bubble

It is impossible to predict what may happen. You need to be sized correctly and go ahead with the surgery. I would use silicone implants

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

Potential for Double Bubble - is There Anything I Can Do?

Double bubble deformity happens when the breast crease is lowered to accommodate an implant, but the old breast crease persists somewhat, leaving a crease in the lower breast. This disturbs the usual smooth convex curve from nipple to breast crease by leaving an indentation across it.

The old crease sometimes resists disappearing because there is some memory in the tissue, caused by connective tissue fibers. These can be released during surgery to improve the situation, but it does not always eliminate the double bubble completely.

Any time you lower the fold this is a risk. If you have a high fold or constricted breast, the risk is present because you usually have to lower the fold in these cases to get a good final breast shape.

There is no way to eliminate this risk; however, the best thing you can do for yourself is find a board certified plastic surgeon who does a lot of cosmetic breast surgery and is used to these sorts of cases.

Best wishes,

Michael Vennemeyer, MD

Michael Vennemeyer, MD
Southlake Plastic Surgeon
5.0 out of 5 stars 48 reviews

Potential for Double Bubble - is There Anything I Can Do? (photo)

I find that the use of adjustable implants are very beneficial in patients with a tight lower pole,especially where asymmetry exists

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Risk for Double Bubble

Patients who have a short distance from the areola to the inframammary crease are at at higher risk for a double bubble deformity.  This is especially true if there is a very tight inframammary crease.  I recommend a periareolar approach for implant placement of the implants in these patients.  I would also caution to go for a smaller volume of augmentation.  Finally, you have very thin tissues and not a lot of coverage in the upper pole and a partial submuscular augmentation would probably be most appropriate.

Michael Sundine, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 18 reviews

Potential for Double Bubble - is There Anything I Can Do?

Yes in your type of anatomic issue of smaller lowr pole. I recommend fat grafts with the implants and stretching of the inferior dermis by puncture techniques. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

No doublebubble

It would behoove you to consider subglandular placement to avoid the chances of the "double bubble". The double bubble is most offen an issue when a patient has a mubmuscular placement of the implants with more ptosis (sagging)than you seem to have. Either one of your implant choices placed over the muscle is going to provide a beautiful result. All the luck.

Marshall T. Partington, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 80 reviews

Are you at risk of double bubble after a breast enlargement?

Looking at your photographs, I do not feel you are particularly high risk for double bubble.

Personally, from what I can see in your photographs, I would suggest a shaped (anatomical) silicone implant, placed partly under the muscle (dual plane technique). This should help fill out your breast below the level of the nipple and provide a nice natural outcome from your breast enlargement. 

Good luck!


Marc Pacifico, MD, FRCS(Plast)
London Plastic Surgeon
5.0 out of 5 stars 47 reviews

With minor breast skin laxity, a double bubble is unlikely.

I would not worry too much about a double bubble.  You are having good-sized implants inserted and I don't think you will have much loose skin after having the implants and certainly not so much loose skin that a lift procedure would be needed (this could always be done later if necessary).  There is less risk of loose skin hanging with larger implants than smaller ones.  I agree with your selection of silicone gel.  I usually recommend gel over saline in women with very little breast or fatty tissue.  Both moderate plus and high profiles are fine.  I would not choose a moderate profile because there is not enough projection with this style.  You are likely to be very pleased.  I have attached a link to my website in case you want to look at some examples, including women similar to you.

Eric Swanson, MD
Kansas City Plastic Surgeon
4.7 out of 5 stars 56 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.