24, 5'7, 135lbs, double bubble deformity after 400 & 450cc 4 years ago, seeking advice (Photos)

Thank you for your question. A large portion of my practice is dedicated to breast revision surgery, and I have been in practice almost 30 years. I have developed many techniques in relation to revision breast surgery. In your case, you would benefit from a capsulorrhaphy-internal bra to elevate your breast pocket higher on your chest and a lollipop lift. You should be able to have an excellent result. Best wishes to you.

Dear Minc4211,
though rare, some women who undergo breast augmentation will develop a minor deformity known as a “double bubble,” in which additional folds appear underneath the breasts due to the implant accidentally shifting or contracting post-surgery. In most cases, the implant simply slipped too far down the chest wall and traveled behind the breast inframammary crease (the area where the lower breast meets the chest), instead of moving forward to fill the breast cavity. If left untreated, the lopsided implant will form unnatural indentations, resulting in an odd “four-breast effect” rather than the full, rounded chest the patient initially desired.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Flexing is normal with implants placed behind the breast. However, on your last photo, one breast does show some asymmetry at the lower medial fold. this could be improved. In the future, please submit photos standing with both arms down by your sides, both front and side views.

Based on your nicely post of photos, you have the standard flexion deformity or double bubble effect of breast implants placed under the muscle. Revision is to replace implants into the dual plane location revision surgery fee $10,000-$15,000. Best of virtual consult with.

Breast augmentation outcomes are generally based on three variables.
The first variable is the patient candidacy for the procedure in the first place.
The second variable is implanted selection in regards to size shape and type.
The third variable is the surgeons ability to place the implant in the correct anatomic location.
Your before pictures shows that your breast sit wide on your chest wall, and you have significant breast divergence more on the right than on the left side.
These characteristics tend to be amplified and put on display with the projection of breast implants.
When plastic surgeons place implants under the pectoralis muscle, part of the muscle needs to be cut or separated from the rib cage.
Each plastic surgeon will have their own way of doing this and some providers cut the the muscle higher while others will leave the muscle more attached to the rib cage.
The approach to how the pectoral is muscle is handled during the procedure can influence how the breast looks during contractions of the muscle.
It’s not uncommon to have some deformity of the implant with contraction of the pectoralis muscle implants are placed below the muscle.
We usually don’t judge breast augmentation outcomes based on the breast appearance with contracted pectoralis muscles.
That said ideally contracting, the muscles should not have too much imp on what the breast looks like, but some of this is inevitable.
Most people have their left breast sitting higher on the chest wall than the right side.
This is true for you as well.
You may have developed some droopiness of your breast since your initial operation.
You’re not quite at the point of needing a breast lift but at some point you may want to consider that option.
Using excessively large implants will always increase the chance of having undesirable side effects, complications and increased in need for revision surgery.
I’m not saying that your implants are excessively large, but the bigger the implant the more patients will have these problems.
Best,
Mats Hagstrom MD