Can I ask my surgeon to reinforce the pocket to prevent double bubble and the implants moving to the armpits?

Question

I have a B.A consultation coming up. I heard about double bubble & the implants moving to the arm pits. Can I ask the surgeon I choose to reinforce the pocket to prevent this from happening? Also would it be wise to go 100 ccs larger since it is going under the muscle?

William Bruno, MD · Answer

If you are concerned about double bubble or implant malposition, you can inquire about using an internal support device. I prefer Galaflex which is dissolvable and adds strength to the repair- it will be reabsorbed in 18 months and replaced with collagen.

Best wishes,
Dr.Bruno

Best wishes,
Dr.Bruno

Kenneth Hughes, MD · Answer

Surgical expertise and good judgment are the most important factors in preventing double bubble and implants moving to the armpits. Submuscular placement affords placement of smooth implants, less long term rippling, greater camouflage, and probably a reduction in tissue thinning over time.
A review of your medical history and photos from front and side with arms down at your sides would be helpful in discussing all your breast implant questions with a board certified PS via email or Skype. An in-office evaluation will occur during pre-op.

Elisa A. Burgess, MD · Answer

For my patients, the first surgery sets the tone for the outcome and accuracy in technique and implant placement are very important. Anatomy also plays into this outcome and we frequently have to dance around this for a good result. We would reserve more complicated breast techniques for secondary surgeries, which are usually not necessary. Make sure to see a board certified plastic surgeon with breast experience.

Joshua Cooper, MD, FACS · Answer

- During a breast augmentation consultation I personally discuss with my patients everything about the technical aspects of the procedure, potential complications, and the recovery process. 
- "Double bubble" and implants migrating laterally towards the armpits are rare complications that every experienced plastic surgeon takes care to avoid automatically with each breast augmentation case. 
-  Therefore, you shouldn't have to request that the above mentioned complications don't occur. ;) 
- As far as sizing for implants is concerned, we have all of our breast augmentation patients do sizing in our office at least twice to pick the right implant.  This involves trying on actual silicone implants in a bra. 
- Best of luck to you!

George Marosan, MD · Answer

Thank you for your question. The consultation is the process where you get to know your prospective surgeon and the surgeon gets to know you. This is the time to ask your questions. The surgeon should be able to answer these based on your conversation and physical evaluation. He/she should have a plan based on your desires and anatomical constraints, should be able to determine if you need pocket reinforcement or not. Double bubble and implants moving into the armpits are technical issues which happen with over dissection of the pocket and or inadequate muscle release. Breast augmentation surgery involves meticulous dissection of the pocket, no bleeding at all, no drains, choice of the appropriate implant, fixing the inframammary fold, etc. Good luck with your consultation.

Daniel Barrett, MD · Answer

Dear seahawk2,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. 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

Ram Kalus, MD, FACS · Answer

You should be able to ask your surgeon any and all questions. If you do not feel good about the answers you should seek a second opinion. Double bubble can be related to many things but most often it is the implant falling below your existing breast fold, which does not mean the implant "slid too low", but rather than your own nipple to fold distance is relatively short and that your fold need to be lowered for aesthetic reasons. In most primary breast augmentations it is not necessary to use mesh or other support materials if the implant is not too large or heavy, and the patient is healthy with normal tissue.

Without a consultation and an examination in person it is difficult to explain all the nuances and details related to a breast augmentation, all of which you deserve to know before scheduling your surgery. I advise all of my patients to use photos of their "ideal" to communicate their visual desired endpoint to their surgeon. Best of luck to you.

Without a consultation and an examination in person it is difficult to explain all the nuances and details related to a breast augmentation, all of which you deserve to know before scheduling your surgery. I advise all of my patients to use photos of their "ideal" to communicate their visual desired endpoint to their surgeon. Best of luck to you.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  In most instances reinforcement is not needed but if you would like the extra safety measure performed, I'm sure your surgeon would be willing to entertain your requests.

Connie Hiers, MD, FACS · Answer

Do discuss your concerns with your surgeon, but I don't think extra reinforcement will be necessary. I would discuss what range of sizes best fits your frame and tissue, and avoid going beyond that range.

Can I ask my surgeon to reinforce the pocket to prevent double bubble and the implants moving to the armpits?

Answers (9)

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