When I raise my arms, is this normal or a “double bubble”? Is this implant too wide for my chest wall? (Photos)

Question

I had a 1st time breast augmentation 20 months ago with Sientra oval base textured shaped 330cc implants, submuscular, with an inframammary approach. I noticed this problem immediately after but was told that my breast tissue just needed to settle around the implant.

Daniel Barrett, MD · Answer

Dear JustInterested100,it is hard to tell for sure without an examination but based on your photos, it looks like you might have a double bubble deformity. I would suggest you to consult your plastic surgeon or ask for a second opinion. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Nilesh Sojitra, MSc, FRCS (Plast) · Answer

this appears to be a double bubble deformity. Incorrect choice of implant and positioning usually .
Please consult your surgeon 
All the best 
Nilesh Sojitra

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast augmentation surgery.  It looks like you have "double bubble" appearance after breast augmentation surgery. A "double bubble" is a cosmetically undesirable circumstance for patients with breast implants, which occurs when the breast fails to take on the shape of the implant, resulting in the appearance of a visible line showing a separation between the bottom edge of the implant and the bottom edge of the natural breast.   Double bubble "deformities" may be more striking (visible) when breast implants have bottomed out. The deformity becomes more striking with pectorals muscle flexion.
There are several options when it comes to revisionary surgery to improve your outcome.  One option is to eliminate the pull of the pectorals major muscle either by completely releasing it or by suturing the muscle back down, thereby placing the breast implants  in the sub glandular position.  Patients who choose to have breast implants placed in the sub  glandular position should have enough breast tissue coverage to allow for this conversion. There are disadvantages of placing breast implants in the sub glandular position (such as increased risk of breast implant encapsulation) which should be considered as you make your decisions.
Another maneuver that may be helpful is raising the inframammary fold using capsulorraphy techniques. In my practice, this type of repair involves a two layer, permanent suture repair (reconstructing the inframammary fold areas). This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly.  Radial incisions along the lower breast poles might help to reduce the deformity as well.  Sometimes, depending on factors such as quality of skin along the lower breast poles, additional support provided by acellular dermal matrix or biosynthetic mesh may be very helpful. I have also found the use of acellular dermal matrix very helpful in cases where the skin/tissues are very thin and in cases of recurrent breast implant displacement. The acellular dermal matrix helps improve contour, improves irregularities caused by the underlying breast implant and/or scar tissue, and provides additional support ("sling" effect) for the breast implants. I hope this helps. Best wishes.

Ronald V. DeMars, MD (Retired) · Answer

Yes, that is what is known as a double bubble and can occur when the implant sits lower than the true breast fold.The implant does not look too wide, but rather too low. This can be corrected with internal suture closure of the lower pocket and converting the implant position to a dual plane. Your breast tissue is where it is and will not "settle".

When I raise my arms, is this normal or a “double bubble”? Is this implant too wide for my chest wall? (Photos)

Answers (4)

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