What is Double Bubble?

There are women who end up with "double bubble" after breast augmentation. Please explain specifically what double bubble is, how it happens, and how it can be corrected. Thank you!

Doctor Answers 7

Defining "double-bubble"

Like "capsule contracture", there is a fair amount of disagreement and definitional problems with the term "double bubble" as well as causes and corrections. 

In my opinion and experience, a double-bubble contour is not caused by the previous inframammary crease which many mistakenly think it is. The problem is caused by subpectoral placement of a breast implant where the pectoralis muscle is released from its origins on the ribs behind the lower half of the breast and is then not released adequately (dual plane release) so that it is no longer behind the breast tissue in the lower half of the breast. If it stays behind the breast tissue in the lower pole, it sometimes attaches to fascia or breast tissue anterior to it and pulls on this and causes the contour deformity. Over-releasing the pectoralis from the medial side of the breast can aggravate this. True double-bubble is fairly easy to diagnose because flexing the pectoralis muscle makes the contour of the double-bubble worse. 

If properly released and reestablished, the old inframammary crease of the breast should not cause a true double-bubble but it can cause a deformity if the implant drops below the level of the intended inframammary crease level. This is fairly easy to diagnose, particularly if the original incision to put the implant in was at the level of the planned inframammary crease. 

A true double-bubble requires an open capsulotomy and release of the pectoralis muscle out of the lower pole of the breast. The slip or stretch of the inframammary crease requires an open procedure to retuck the inframammary crease level. 

Double-bubble can happen on one side and not the other and there are some other potential aggravating conditions such as a lower-pole constricted breast, improperly sized implants, and ptotic breasts. 

Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

What is a Double Bubble?

A Double Bubble is the appearance of an augmented breast when the implant causes a second bulge below the natural crease of the breast. This causes two curves beneath the breast. The Double bubble most commonly occurs when the lower portion of the pectoralis muscle is not released enough from the breast tissue and creates an indentation or groove. It can also occur if the crease is very tight and the implant slips below the crease. Certain shapes and sizes of breasts can increase the chance of a Double Bubble. Choosing implants that fit your anatomy will help prevent this from happening. The best treatment is prevention.  Good luck.

Ronald Schuster, MD
Baltimore Plastic Surgeon
4.9 out of 5 stars 77 reviews

Double Bubble after Breast Augmentation

   I do about 500 or 600 breast augmentations a year, and I can assure you that this result is not common at all.  The only time I have seen double bubble occur is when it is necessary to release the IMF with a constricted or tuberous breast.  The implant falls below the breast producing the double bubble.  In standard breast anatomy, I have not seen it and it does not have to occur, ever.  The double bubble can be fixed with pocket revision.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

What is Double Bubble?

The double bubble is a condition after breast augmentation where you see the curve and fullness of the implant below the curve and fullness of the breast. Assuming you use an implant of the right size and it is positioned inside the lines of the natural breast tissue you should not have this problewm.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Double bubble deformity

there are 2 conditions called double bubble deformity after implant placement. the first one is when the breast tissue ends up falling in front and below the actual implant and the other is when the implant ends up partly below the skin crease. both situations have been called double bubble and both will require surgical revision and relocation of the implants with or without crease repair.

Antoine A. Hallak, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 5 reviews

Double bubble caused by mismatch between diameter of breast and diameter of implant

When the diameter of the implant is larger than the diameter of the breast, a double bubble appearance ensues (wedding cake).  This can be because of augmentation of a constricted breast with correcting that anatomic problem. It may also occur when the inframmary fold is violated by a large implant placement in a breast of any anatomic shape.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

What is a "double-bubble" in breast augmentation?

A "Double-Bubble" occurs when the breast fold has been over-dissected and the implant falls below he breast fold which creates a band over the lower pole of the breast.  This looks unnatural.  The best thing to do is to avoid this complication from the beginning because it is very difficult to correct.  Correction often involves placement of a smaller implant and suturing the breast capsule at the natural level of the fold back down to the ribs with permanent sutures.

In my practice this problem simply doesn't occur.  I often use an incision at the breast fold or around the areaola and by careful tissue dissection and retraction the procedure can be completed without disturbing the breast fold.  Even large implants can be used by this technique without disturbing the fold by adding a "dual-plane" dissection.

Good luck and make sure you consult with a board-certified plastic surgeon.

Jason E. Leedy, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 126 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.