Double bubble or bottoming out? Can it be fixed? (photos)

Question

I had my BA in may 2021 and haven’t been happy with the results. I got 500cc mentor HP silicone in my R, 400cc mentor HP silicone in my L. I have had pain/uncomfortable in L since beginning, and some tenting in between breasts. I wear a bra 24/7. PS doesn’t seem concerned. But I am super embarrassed by the look of them, this isn’t what I paid over $10,000 for. Can this be fixed? It effecting my self esteem majorly. I was self conscious about my breast before but now I don’t even want to see em

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs and I am sorry to hear of your augmentation difficulties. Unfortunately both implants have bottomed out and you will require a revision procedure to fully correct your results.  Depending on your tissue quality you may wish to reinforce the repair with mesh.  Seek out a series of consultations in your area to get the best advice.

Donald R. Revis Jr, MD · Answer

Good morning,
You do have some bottoming out and double bubbles. I correct this with the Original Internal Bra, my strong permanent internal suturing technique, which will also improve your upper pole fullness and cleavage. I first developed this technique over 20 years ago, and today it is the most common revision procedure I perform, at least 5-6 times a week- it works and it lasts!

Christopher V. Pelletiere, MD · Answer

Sorry to hear about your unhapppiness.  It is never easy when someone doesn’t achieve the desired outcome from surgery.  In your case, it looks like you are seeing the actual breast tissue delineation off the implant when you move/flex.  It can happen if the implant doesn’t fill in the soft tissues and take up enough space, or a lift isn’t performed to address some natural ptosis.  There are a number of ways to correct this but without an in-person consultation it is hard to say what will work best for you.  I would address this with your surgeon or go for a second opinion with a board certified plastic surgeon.  I hope this helps.

Leyla Arvas, MD · Answer

Hello, this is a double bubble complication. It needs to be operated again. It is necessary to change the implant pocket plain where the implant is placed through the same incision line.

Gerald Minniti, MD, FACS · Answer

Double bubble is a form of drop out, and you have it, along with near symmastia. This can be fixed. Either capsulorrhaphy with mesh or a neosubpectoral pocket will fix it, my preference that latter because of your medial malposition.

Daniel Barrett, MD · Answer

Dear Powerful290223,
though rare, some women who undergo breast augmentation will develop a minor deformity known as a “double bubble,” in which additional folds appear underneath the breasts due to the implant accidentally shifting or contracting post-surgery. In most cases, the implant simply slipped too far down the chest wall and traveled behind the breast inframammary crease (the area where the lower breast meets the chest), instead of moving forward to fill the breast cavity. If left untreated, the lopsided implant will form unnatural indentations, resulting in an odd “four-breast effect” rather than the full, rounded chest the patient initially desired.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

From the photos it appears you are correct that a double bubble is present.  You can consider exchanging the implants for a smaller volume and/or consider adding bioabsorbable mesh.  This will provide more support to the bottom of the breast to help with the weight of the implants.  I've included a video I hope you find helpful.

Connie Hiers, MD, FACS · Answer

Your heavy implants are bottoming out from the weight.  I would suggest exchanging them for something smaller that fits your frame and tissue better and tightening your lower pockets. If you try to keep these sizes, the repair may not hold.  It is possible that your inferior pocket was lowered in surgery to accommodate these sizes of implants.  Your surgeon can say for sure.

Derek Fletcher, MD · Answer

There are several causes of double bubble deformity following breast augmentation. One common cause is inferior malposition (falling) of the breast implant below the inframammary fold (breast crease), which is what appears to have happened in your photos. Correction of double bubble deformity due to falling of the implant below the breast crease must achieve the following goal: repositioning of the implant within the natural boundaries of the breast above the breast crease. This can be achieved by using a new implant pocket, smaller implants, strategically placed sutures, biologic mesh support, or a combination thereof. Using smaller implants is an important consideration as smaller implants tend to impart less stress on the boundaries of the breast because they are smaller in diameter and lighter in weight. However, this strategy must be balanced against your breast size goals and the potential need for a breast lift.

Jason Pozner, MD · Answer

You have bilateral fold malpostions - meaning the implant descended below the natural fold causing a double bubble. This is also called bottoming out but that term can be confusing as it also includes inferior stretch - when the fold is good but the breast skin stretches

to correct i would raise the fold and use galaflex mesh for support. i would use the same implants unless you wanted a size change

to correct i would raise the fold and use galaflex mesh for support. i would use the same implants unless you wanted a size change

Double bubble or bottoming out? Can it be fixed? (photos)

Answers (11)

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