Is double bubble correctable without surgery? (Photo)

Question

I am 11 days post op and pretty sure my left breast is developing double bubble and it also looks like its leaning left. Needless to say, I am concerned. Is double bubble correctable without surgery? I am so disappointed and nervous for the result. What options are available to fix double bubble?

Gary Lawton, MD, FACS · Answer

At 11 days you are no where near your final outcome.Implant massage is a critical part of the postoperative recovery from breast augmentation (like physical therapy is a critical part of the postoperative recovery from knee surgery).  The space for the implant is meticulously crafted at the time of augmentation surgery, especially when the operation is performed using the surgical endoscope through the transaxillary approach.  However, the distance from the nipple to the inframammary fold needs to stretch out to accommodate the implant (dropping) and the skin and muscle need to relax to give the desired shape (fluffing).  Implant massage allows you to manipulate the pocket from the inside to direct the forces in the appropriate directions to mold the breast shape to the desired outcome.  If the scar that is actively forming around the implant is allowed to heal without the influence of breast massage, the fold will not stretch appropriately (implant stays too high), the scar will attempt to contract in a linear way over the curved surface of the implant (breast shape will remain too flat), and the space will attempt to heal smaller and tighter than the implant (capsular contracture).  Implant massage influences the scar formation on the inside at the most critical phase of the healing, allowing the space to be larger than the implant (mobility which creates the natural feel and bounce).

Implant massage starts at one week at 5 times per day for one minute at a time and continues at this pace until one month.  I often see the patients weekly during this time to reinforce the technique and help the patients who need extra effort to soften the breasts. During this time period, the massage also breaks up the spasm, relieving the discomfort, particularly upon awakening from sleep (morning breast).  During the day, every time there is the sensation of tightness, implant massage breaks up the spasm and relieves the discomfort, minimizing the need for narcotics.  At one month, the force that can be exerted is increased but the frequency of massage decreases to 3 times per day.  As the wound matures, the massage can decrease to once per day forever as maintenance.  The patients integrate this into their shower routine.

Although some patients can get away with no massage, it is a common issue for those who stop the massage and make none of their follow up appointment to suddenly show up years after surgery claiming that they woke up one morning with a capsular contracture and implant malposition.  Of course this did not happen overnight, but was a slow process that could have been prevented with daily maintenance massage and regular routine follow appointments on a yearly basis (which we provide for free, forever). With this type of perpetual follow up, it is possible to identify a problem early that might need a modification in the massage technique.

Implant massage involves moving the device up against the wall of the pocket, holding pressure against the surface of the scar. The specifics are determined on an individual basis guided by what the patient needs. In some patients it is simple and of little significance.  In some patients it is a struggle to get the implants into the right position and to gain softness and mobility, but with the right technique and the appropriate dedication it is a huge success.  For the patients that do not participate in the massage in a meaningful way, some will get away with their lack of dedication because they were going to have soft breasts no matter what.  On the other hand, some patients will squander their opportunity to have an excellent result because they don't believe that the massage is necessary, or because they have been told by their friends or other doctors that they didn't need to perform massage.  Regardless, they often require surgery that could have been avoided by following the postoperative instructions of a surgeon that has performed nearly 10,000 breast implant operations and has seen the healing of each of those patients and integrated the successes and failures of each one into a postoperative plan that really works.

I find no use for bands, straps, bras or appliances after breast augmentation surgery.

Jed H. Horowitz, MD, FACS · Answer

HEALING AFTER BREAST
SURGERY, AUGMENTATION, LIFTS

1.   
pain is variable

2.   
it takes 2-3 months for implants to settle and muscles to relax

3.   
celebrex, motrin, and muscle relaxers can help

4.   
massage and stretching may help

5.   
everyone heals differently

6.   
4-7 days off from work is common

HEALING OF SENSORY NERVES: Tingling, burning or shooting pains, which will disappear
with time and should not alarm you, indicate regeneration of the sensory
nerves. If these sensations cause pain, repeated, local self-massage helps.

ASYMMETRY: The two breasts commonly heal quite differently. One
breast may swell more, feel more uncomfortable, or have a different initial
shape. After complete healing, they will be more similar and natural. You must
have patience, but if this causes concern, ask questions of the doctor or the
nursing staff.

SHAPE AND CONTOUR: The final shape of your breasts will start to look its
best approximately three (3) months after surgery. It takes time for the skin
and muscle to stretch and relax around the new implant. The breast will often
look higher, firmer, and “less natural” in the first three (3) months. It can
take up to a year to see your final result.

FOLLOW-UP EXAMS: These are generally done in 1 week, 2 to 3
weeks, 3 to 6 weeks, 3 months, 6 months to 1 year, and 1-2 year intervals. In
our office we include all of your follow up appointments in the initial
surgical fee.

ALWAYS CONTACT YOUR PLASTIC
SURGEON IF YOU HAVE CONCERNS ABOUT INFECTION, BLEEDING, SWELLING, FEVER,
EXCESSIVE BRUISING, OR ANY NEW AND SUDDEN CHANGES IN THE FEELING OR LOOK OF
YOUR BREASTS/IMPLANTS.

M. Scott Haydon, MD · Answer

Thanks for your question and the photos. It is hard to give much advice without seeing preop photos or knowing what type of implant was used. It looks like you might have had some constriction on that left side and an attempt may have been made to lower that crease and release the lower pole internally. Oftentimes this will smooth out over time and be less pronounced. The only time it is a concern is if the lower area is so weak that the implant bottoms out and gets too low. Best of Luck!

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