Subpectoral to Subglandular to Help Double Bubble?

I am 6 weeks post breast augmentation. I went subpectoral, style 20-400ccs, natrelle silicone gels, inframmary crease incision, although my crease was lowered to provide more adequate skin length between nipple and fold. I had what I assume was some ptosis of the breast because all doctors who have seen me say I had a very mild case of tublular distortion. I requested a more full (rounded teardrop) shape. I am 29, 5'8, 155-160lbs. I am unhappy with final result as I have double bubble and pointy breasts with no lower fullness. Should I revise? Larger implants, subglandular?

Doctor Answers 12

This can be corrected with Fat

This is Dr Del Vecchio.  I have a large series of double bubble cases that are due to the constricted breast lying on top of a well-placed implant.  This is not a problem of the implant being in the  wrong position, but rather of the soft tissue of the breast failing to drape over the implant in a smooth manner.  Nobody can predict 100% of the time who will get this- but it often is seen in dense constricted nulliparous (no children)  breasts.  There is a different double bubble deformity that is due to implant placement being too low- but in your case the implants are perfect. 


This problem can be addressed without having to do anything to the implants--- simply by fat grafting and weakening the native infra-mammary folds that do not want to go away!   Although I have not yet published this,  I have several cases I could share with you.  But the Overall message is that this can be addressed effectively!


Best regards,

Boston Plastic Surgeon
4.5 out of 5 stars 180 reviews

Subpectoral to Subglandular for Double Bubble?

Wait 6 months or more for your implants to settle to decide if  a dual plane release or subglandular position is neccessary. Your will probably need a left capsulorraphy to raise the left fold and correct the double bubble.

Daniel J. Casper, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 19 reviews

Double Bubble Deformity

At this point you need to wait until you are about 4-6 months postop.

I would say that you have tuberous breast deformity and that the native breast tissue was not scored enough and that possibly the implants were place behind the muscle, instead of dual plane or subglandular.

See how things look in about 4-6 months, at that point if you are unhappy then a revision surgery can be performed.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 78 reviews

Double Bubble problem

You are still very early in the post operative recovery period.  Give it more time for the implant to stretch out the inferior segment.  If the problems persists at 6 months then may consider an inferior capsulectomy.  I would not think that a site change to subglandular would help since most of the flat area is subglandular at this point anyway.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Double bubble

Lowering the fold causes the double bubble. You will need to wait a few months and then the surgeon will need to go back in and raised the fold back up.. You may want to consider smaller implants as well.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

A definitive and immediate solution is to transfer the implants to the subglandular plane

The attempt to lower the position of your left breast fold with the implant in the submuscular position is the reason the double bubble developed. The most straightforward approach to correcting this problem is to reposition both implants in the subglandular position. The only drawback to this procedure is if you did not originally have adequate breast tissue by itself to cover the implant. If you do not have sufficient tissue the subglandular positioning could result in another problem of visible rippling on the breast surface.

Your surgeon should know if originally you had enough tissue to cover the breast in the subglandular location. The fact that you are using gel implants will help since they have less chance of demonstrating rippling in the subglandular plane. There is no need to delay the surgery because I do not believe that the problem will spontaneously improve by delaying surgical revision. I have corrected this problem many times by going from submuscular to subglandular.

David A. Ross, MD (retired)
Chicago Plastic Surgeon
4.6 out of 5 stars 89 reviews

Tuberous Breast Deformity and "Double Bubble"

A review of your BEFORE pictures would very likely demonstrate pre-existing breast asymmetry, constricted / tuberous breasts with large areolas. This presentation is notoriously challenging to correct to a completely normal, attractive breast. the Double Bubble deformity is a reflection of incomplete release of the fibers constricting the breasts resulting in retained "memory" of the former breast shape with inability to curve over the implants and present the shape imparted by the implants.

At this point in your recovery, I would wait and allow time and gravity to work. There will be a significant improvement with time which may be satisfactory. If after 6-8 months you are still bothered by the appearance and wish to take on the potential complications of revision surgery, then I would perform the surgery through around the areolae incisions to decrease their size, release any remaining constriction with radial cuts, correct the left lower pocket deformity, if still there, and do a periareolar breast lift, as needed, for better symmetry.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 109 reviews

Double bubble and tuberous (tubular) constricted breasts following implant augmentation

In some instances this can be repaired with an approach called the biplanar. In this surgery, the implants are kept in the submuscular pocket but surgery is performed above the muscle to release the parenchyma and breast gland with radial relaxing incisions to allow the tissue to become more full and rounded. Your crease is low and it may require a caspsulorrhaphy. Generally I prefer to wait for 4-6 months following the intial procedure prior to performing revisions.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 reviews

Revision breast augmentation in Manhattan.


Based on the one picture, you probably need :

1) Correction of tubular deformity by releasing lower breast tissue and a modified breast lift to make your areolas smaller.

2) Putting slightly smaller breast implants over the muscle.

3) Raising the fold under your left breast.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Tough starting points from breast augmentation

While they don't want to hear it, it is important for some patients to understand that they have a tough starting point and can't have as easy an experience or result from a breast augmentation as others with better starting points. You needed to hear that before surgery so you would be more patient now with the recovery. Give it 4-6 months and then see where you are. Rushing into an early revision would be a mistake.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 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.