Breast Augmentation Bottoming out or Double Bubble Effect?

I am four months post op from breast augmentation. I am able to feel the entire bottom of breast implant at the crease of my breasts. I am scared that way my breasts look I am either having the bottoming out effect or the double bubble effect. Is this an occurence in either complication?

Doctor Answers 25

Let's find out!

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Being able to "feel" the implant at the inframammary crease level is normal especially in thin patients and especially with saline implants. This is not bottoming out or a double-bubble.

"Bottoming out" occurs when the implant descends below the crease and the breast loses its fullness in the upper pole as it settles into the lower pole. If you have a crease incision, you will see it riding up onto the lower pole of the breast.

A "double-bubble" occurs when the inframammary crease is lowered to form a new crease farther down and the old crease retains a memory and creates an indentation across the lower pole above where the new crease forms.

Both of these problems can be treated but sometimes they aren't easy to fix.

Are you bottoming out?

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You should make an appointment with your surgeon for an in person consultation. If you are bottoming out then here is some information which could help you.

Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.
Bottoming out and Side Boobs Contributing Factors:
  1. Larger/Heavier Implants
  2. Implants placed above the pectoralis muscle
  3. Chronically not wearing a bra when upright
  4. Over dissection of the Implant Pocket
  5. Smooth Implants
  6. Large swings of weight including pregnancy
  7. Skin and soft tissue laxity, loss of elasticity

Implant position is important

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The implant can be felt along the bottom of the breast without there being a complication.  The shape of the breast will determine whether the implant is at the right level.

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Breast Implant Bottoming Out Different from Double Bubble

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Thank you for your question. Bottoming out refers to the Breast Implant dropping low under the breast and creating the appearance of the breast mound below the Nipple-the Nipple -Areola appears too high on the breast. With Bottoming Out of the Breast Implant however, the Inframammary Crease-the fold beneath your breast is intact.

The Double Bubble Breast Implant occurs when the Inframammary Crease is violated and the Breast Implant slides below the crease. This creates a second area of fullness below the crease on side view-a second bubble. The Inframammary Crease appears on top of this second bulge instead of below the breast as is the normal case.

See your Plastic Surgeon for an exam.

You would need to be examined

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It's difficult to know without an examination, but both bottoming out or a double bubble can happen after breast augmentation. On the other hand, if you are thin and had saline breast implants, the edges of the implant can be felt (this can sometimes occur with silicone implants, although it's less common).

I would discuss your concerns with the surgeon who performed the procedure, and if needed, seek a second opinion with a Board Certified Plastic Surgeon in your region. If everything is ok, this will at least alleviate your concerns. If not, either problem can be improved, but depending on how severe the problem is, it may not be corrected completely.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

Bottoming out

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It is not uncommon for the implant to be palpable at the lower portion of the breast - especially in thin patients. If your implant is above your fold you do not have bottoming out or double bubble. If you are concerned about the appearance of your breasts it is best to make a trip to your surgeon's office so that he or she can examine you. 

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 152 reviews

Follow up with your surgeon

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These complications have occured, however it is difficult to diagnosis without an examination. If you are unhappy with your results or if you feel something is wrong or does not look right, you need to contact your doctor. He will examine you and determine if either of these are happening or if you are a thin patient, you will be more likely to feel the implants more than other patients.

If you are unsure about your results dont hesistate to contact your doctor, it is best to address your concerns as soon as possible.

Chia Chi Kao, MD
Los Angeles Plastic Surgeon
3.0 out of 5 stars 2 reviews

Breast Augmentation Bottoming out or Double Bubble Effect

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A "Double Bubble" or “Snoopy” breast develop as a result of the weight of the implant; commonly when a breast lift is not included with a breast augmentation.

Meanwhile, "Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.
Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant.
This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold. Your board-certified plastic surgeon will discuss which approach is best suitable for you based your current concern.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Bottoming out after a breast augmentation

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It is not unusual to be able to feel the implant but bottoming out typically doesn't occur so soon. For your individual situation, you should speak with your surgeon about some of your concerns.

Bottoming out

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Without a photo, the only way you can tell if your implants are bottoming out is with an examination by your surgeon. It is normal to feel the bottom of the implants, therefore you shouldn't be worried about this.

Ronald Levine, MD
Toronto Plastic Surgeon
4.6 out of 5 stars 25 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.