From above the muscle to dual plane? (photo)

I had 280 and 300 ml implants placed above the muscle and decided to get 375 and 400 ml under the muscle (dual plane). My doc said it would correct the sagging but now I have a double bubble breast. I'm only 2 weeks post op and he said the skin will attach to the implant and correct this. But I'm afraid it will sag again over time as it seems to be very loose. Is it normal? If it doesn't get fixed would changing the implants to above the muscle fix it?

Doctor Answers 3

Concerns after revisionary breast surgery from above the muscle to dual plane?

Although I do see your concern, it is too early to evaluate the outcome of the procedure performed. 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. Sometimes, in situations like yours, the appearance of the breast improves over the course of the first several months; sometimes, additional surgery may be necessary to improve the outcome.

Generally, 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. 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, and the attached link, helps.
Best wishes.

Early in recovery phase

 As you are very early in the recovery phase, and the sub muscular pocket has more tension holding the implant upward then did the sub glandular pocket, there is still time with gravity and relaxation of the muscle that the settling of this left implant will round out the bottom. I would wait a few months before considering any type of revisions. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

Split muscle technique to correct double bubble after dual plane implants

There are two causes of double bubble: one is when the fold is lowered, which does not appear to be the case with you, and the other is the dual plane procedure. This involves detaching part of the pectoral muscle, which then heals into the capsule. If you see the double bubble crease pull up when you flex your pec, then that is the cause and it will not get better with time. You could put the implants back on top of the muscle but the better procedure is to convert to the split muscle plane.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 47 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.