Rippling and muscle deformity. Tissue is too thin. Options? (photo)

Hello and thank you for your question.
It is difficult to provide specific recommendations without a physical examination. However, based on your photographs, you have bilateral implant malposition with "double bubble" deformities. This is clearly worsened by activation of your pectoralis major muscles. I think you would certainly benefit from downsizing your current implants with more cohesive gel devices. I would also recommend changing the plane to the sub fascial position with the addition of galaflex. Fat grafting can also be added to help provide additional soft tissue coverage and minimize implant visibility. These procedures may need to be staged. You should consult with a surgeon certified by the American Board of Plastic Surgery who has extensive experience with breast implant revision procedures. Good luck. I hope this helps.

Dear lingf44,

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

The type of animation deformity that you have requires the muscle to be re-attached, which can be done by converting from dual plane to the split muscle plane. This would enable the upper portion of the implants to retain muscle coverage while eliminating the deformity. You would need an internal bra with either Galaflex or Strattice to cover and support the lower part of the implant. Many examples on my website. A smaller implant will create a mismatch of the skin envelope to the volume of the breast, so not a good idea, but more cohesive would be helpful.