What Are Some Risks I Can Expect Getting Breast Augmentation and How to Prevent Them?

I have read testimonials and seen many a pictures of boob jobs gone wrong. My greatest fear is that the implants will 'bottom out' (when the implants drop and patients nipples are pointed skyward), and double-bubbling. Visually both are VERY unappealing, I would like to know what causes this, how to avoid it, and how often this actually happens to patients?

Doctor Answers 7

Risks of Breast Augmentation Double Bubble and Bottoming Out

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Sa Ra,

Thank you for your important question.

Double Bubble after Breast Augmentation most commonly happens when a patient needs a Breast Lift but only has a Breast Augmentation. To compensate the Surgeon tries to place the Implant too low and violates the Inframammary Fold or Breast Crease. The Implant bulges below the natural Breast and creates a second "bubble."

Snoopy Deformity happens when a Breast Implant is placed in a proper position above the Inframammary Fold or Breast Crease beneath a sagging or Ptotic Breast. The Mound created by the Implant rests above the sagging Breast creating a side profile like the cartoon character Snoopy.

Bottoming out is a more common risk of Breast Augmentation. In this condition the Breast Implant moves down and the nipple is pushed upward. Bottoming Out tends to happen in some people who have lax skin, when a very large implant is placed, or when the Inframammary Fold is incised during surgery. Bottoming out can be corrected by a surgical procedure used to tighten the pocket around the implant and re suturing the inframammary fold.

These potential problems should be discussed with your Board Certified Plastic Surgeon. If you do not have a Ptotic or sagging Breast and do not need a Breast Lift and do not want an extremely large Breast Implant it is unlikely that you will experience any of these problems if you have an experienced surgeon.

Bottoming out and Double bubble are preventable problems in Breast Augmentation

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The double bubble or bottoming out occurs when the inframammary fold (crease at bottom of breast) is too aggressively lowered. This can be caused by the surgeon at the time of surgery or by selecting an implant that is either too large or too wide for your breast/body.

Select your surgeon and breast implants carefully to avoid this preventable problem.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Complications of breast augmentation

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I think the key to breast surgery is to choose both surgeon and implants wisely. I find a lot of patient come in wanting very large implants.  Many times these implants are too large for the body and patient education is key.  Even with this, double bubbling, bottoming out, etc.. can happen but certainly at a lower rate.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Complications of breast augmentation

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Your concern is valid.  In any elective surgery, we want to avoid any complication.  There are potential risks of surgery, most commonly bleeding and infection as well as scar and pain.  Breast augmentation is a very safe procedure when done to healthy patient, and by a qualified plastic surgeon.  There is a potential for double bubble or bottoming out when implants are too large or when the implant pocket is dissected to low.  However, this is rare as well.  You should talk with plastic surgeon who will allay your concerns.  As any surgery, there is a potential risk/complication; however, when they are done by a qualified, board-certified plastic surgeon, that risk should be very low.

Bottoming Out and Double Bubble after Breast Augmentation

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Bottoming out is caused by lowering the lower fold of the breast excessively combined with too large and, therefore, too heavy an implant. 

The double bubble is usually associated with augmentation in breasts that have a developmental abnormality.  The bottom fold is too high or the breast is constricted and tuberous.  These problems need to be corrected at the time of the augmentation.  Again, the breast implant size needs to be appropriate to your breast size and shape.

Discuss these concerns with your plastic surgeon and If you are unsure, always get a second opinion. 

John Borkowski, MD
Hartford Plastic Surgeon

Avoidance Of Augmentation Problems

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I agree with your assessment that bottoming out and double bubbling are very unappealing.  Your best bet to lessen the chances of problems in general is to use a board-cerified PLASTIC surgeon.  You will lessen the chances of developing these specific problems if you choose implants which are appropriate for your breasts and are not overly large.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Breast Augmentation: Complications and Risks, how to get that perfect result

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Breast Augmentation is one of the most common aesthetic surgeries performed.  When performed correctly by a board certified plastic surgeon, you can attain sensual, sexy and perky results in a very safe manner.  When done incorrectly, results can be devastating and difficult to correct.  The important factors to ensure a beautiful final product are: Implant placement (under or over the muscle), incision location, implant size, and implant type (silicone or saline).  I find that silicone implants, placed under the muscle, through an incision placed either in the fold or junction of the areola are the best methods to gain natural, balanced and perky results.  Complications that happen when performed by untrained doctors are implants that fall out of the pocket, implants that touch (synmastia) asymmetry of nipple position and implant positions, capsule formation.  A detailed consultation with a board certified plastic surgeon will help you create a surgical plan to give you SAFE yet extremely sensual and gorgeous results!

John G. Apostolides, MD, FACS
La Jolla Plastic Surgeon
4.9 out of 5 stars 29 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.