Settled but still seem “uneven”? Doctor has retired. What can I do? (Photos)

This is a classic "double bubble" deformity. This happens when the previous inframmary fold is displaced on to the new lower pole of the breast as the implant descends/settles. This is commonly seen when very large implants are placed, tuberous breast deformity, poor technique/implant selection. I would recommend seeing an expert in revisionary aesthetic plastic surgery.

Dear Abner5877,

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

Hello, thank you for your question.
Based on your photographs but without the benefit of a physical examination, it appears that you have bilateral " double bubble" deformities. This occurs when the implant descends below the pre-existing breast folds. This is unlikely to improve without further surgery. Correction typically involves resuspending the inframaammary folds with a capsular repair. You may want to consider smaller implants and possible mesh reinforcement.. If your surgeon has retired, I suggest you consult with a plastic surgeon certified by the American Board of Plastic Surgery who has experience with revisional cosmetic breast surgery. Good luck. I hope this helps.

The waterfall deformity happens when breast tissue begins to descend from the implant to a different level than the device. Not uncommon with implants over 300cc depending on your anatomy and measurements as well as weight fluctuations. I see this commonly in patient who have had those characteristics and are typically 10-15 years out from surgery. Typically after 1 year as you mentioned, not much further change is going to occur, but if you are at a goal and stable weight and otherwise back to baseline health, a surgical revision can address your issues. A breast fold reset is usually advised which involves internal bra support with Galaflex Mesh, implant exchange, internal lift with capsule revision as well as an excision of excess skin. Thanks for asking a helpful question for people to learn from!

Thank you for your question. I have been in practice for over 30 years and revision breast surgery is a large portion of my practice. I have seen your problem many times in my career. In an attempt to avoid performing a lift, your doctor placed the implant pocket to low and violated the inframammary ligament. It is a very straightforward fix, however you will need a internal bra-capsulorrhaphy as well as a lift-mastopexy. You should be able to have an excellent result without a double bubble. Best wishes to you.

Your double bubble appearance is from your original inframammary fold. 600 cc implants are quite large and heavy weighing over 1 lb. each. You would be better off with smaller implants or consider fat transfers with revision to correct the old inframammary fold.

Best Wishes,

Gary Horndeski, M.D.

Your implants are too large and heavy for your tissue and frame and are bottoming out from the weight. You need to go down in size and have the inferior pockets tightened. You might need mesh. Go visit with another plastic surgeon.

Dear Abner, I do not think there is a plastic surgeon around who has not seen your problem. The at the answer to what to do depends on several things. It appears as though your implants are somewhat low and you have the classic case of a double bubble. I am going to assume that your implants are under the muscle and if you flex your chest muscle this creases accentuate and the implants will move more to the side. I am also going to assume although there was not a picture review lying down that when you lay down with out of bra the implants move laterally toward the arm leaving a wider space between the breasts. Assuming that there are several recommendations. I would consider changing her implants from under the muscle if they are to over the muscle which would obliterate this double bubble and possibly the addition of some type of mesh to support the breast. I would also repair the lateral pocket to prevent the implants from moving to 4 to the side. You might also consider dropping down the size a little that because they will look bigger over the muscle then under the muscle. Although I am not familiar with your area I would assume there are several plastic surgeons you could see who might be able to evaluate you and give you a fee for the corrections. It also might be that your doctor who has retired has turned his practice and his charts over to another physician and you might be able to see them as well. Good luck with your decision.

Based on your only two poster photos, best of virtual concert with, but most likely would need an explant and repositioning the pocket to a dual plane or above the muscle potentially. Fee would be approximately eight to $12,000 but again best of virtual concert with.