What is a double bubble breast implant?
A double bubble breast implant is a complication that can occur after breast augmentation surgery, where the breast implant and the natural breast tissue do not align properly, creating the appearance of two distinct bulges or “bubbles” on the lower part of the breast. This results in an unnatural contour with a visible crease or indentation across the lower breast, often described as two parallel folds. It disrupts the smooth, natural shape that breast implants are intended to achieve and is typically more noticeable when standing or raising the arms.
Types of double bubble deformity
There are two main types of double bubble deformity, distinguished by their causes:
- Type 1: Implant Descends Below the Inframammary Fold
- The breast implant drops below the natural inframammary fold (the crease where the breast meets the chest wall), creating a second crease or bulge beneath the original fold.
- Causes:
- Improper Implant Placement: The implant is placed too low during surgery, or the implant pocket is created too low, detaching the inframammary fold from the chest wall.
- Overly Large Implants: Implants that are too large for the patient’s anatomy can stretch the lower breast tissue, causing the implant to descend.
- Weak Inframammary Fold: A poorly defined or weak fold may not support the implant, leading to downward displacement.
- Constricted or Tuberous Breasts: Breasts with a tight lower pole or short nipple-to-fold distance (common in tuberous breast deformity) are more prone to this issue.
- Surgical Technique Errors: Excessive release of the inframammary fold or improper pocket creation during surgery can contribute.
- Type 2: Breast Tissue Sags Over the Implant
- The implant remains in its correct position, but the natural breast tissue sags or slides downward over the implant, creating a second crease or bulge below the implant.
- Causes:
- Sagging Breast Tissue (Ptosis): Pre-existing sagging or significant breast tissue that droops over time due to aging, pregnancy, weight fluctuations, or gravity.
- Capsular Contracture: Scar tissue around the implant tightens, pushing the implant upward while the breast tissue sags, creating a double contour.
- Submuscular Placement: When implants are placed under the pectoral muscle (dual-plane or submuscular), the muscle’s movement can cause an animation deformity, where muscle contraction pulls the implant upward, leaving sagging tissue below (sometimes called “windowshading”)
Risk factors for getting a double bubble deformity
Several factors increase the likelihood of developing a double bubble breast implants:
- Anatomical Factors: Tuberous breasts, short nipple-to-fold distance, tight or constricted lower breast tissue, or a high-riding inframammary fold.
- Implant Choice: Using implants that are too large or heavy for the patient’s tissue support.
- Surgical Technique: Poor implant placement, excessive lowering of the inframammary fold, or use of certain incision types (e.g., transaxillary or transumbilical) that limit precise pocket creation.
- Post-Surgical Changes: Weight fluctuations, pregnancy, breastfeeding, or aging that alter breast tissue and skin elasticity.
- Capsular Contracture: Excessive scar tissue formation around the implant can distort its position.
Double bubble implant symptoms
- A visible crease or indentation across the lower breast, creating the appearance of two bulges (one from the implant and one from the natural breast tissue).
- Asymmetry or droopiness, especially noticeable in profile or when raising the arms.
- Possible discomfort or pain, particularly if associated with capsular contracture.
How to prevent double bubble breast implants
- Choose an Experienced Surgeon: A board-certified plastic surgeon with expertise in breast augmentation can tailor the procedure to the patient’s anatomy, ensuring proper implant placement and pocket creation.
- Select Appropriate Implants: Choosing an implant size and type (e.g., anatomically shaped or form-stable “gummy bear” implants) that suits the patient’s anatomy reduces stress on tissues.
- Consider a Breast Lift: For patients with pre-existing sagging (ptosis), combining augmentation with a mastopexy (breast lift) can prevent tissue sagging over the implant.
- Careful Surgical Planning: Precise measurement of the nipple-to-fold distance and inframammary fold position, along with techniques like the dual-plane method, can reduce risks.
- Post-Operative Care: Following the surgeon’s instructions, such as wearing a supportive bra and avoiding strenuous activities, supports proper healing.
How to fix double bubble implants
Double bubble deformity is typically corrected through revision surgery, with the approach depending on the type and cause:
- Capsulorrhaphy: Suturing the implant pocket to raise or reinforce the inframammary fold, preventing further descent.
- Implant Repositioning: Moving the implant to a higher or more anatomically appropriate position, sometimes switching from submuscular to subglandular placement.
- Implant Exchange: Replacing overly large implants with smaller or differently shaped ones (e.g., form-stable implants with a narrower base).
- Breast Lift (Mastopexy): For Type 2 deformities, lifting and reshaping sagging breast tissue to align with the implant.
- Capsulectomy: Removing scar tissue if capsular contracture is present.
- Internal Bra Technique: Using surgical mesh (e.g., Galaflex) or acellular dermal matrices to reinforce the implant pocket and provide long-term support.
- Fat Grafting: In some cases, injecting fat into the area beneath the inframammary fold can smooth the transition between the implant and natural tissue, particularly for mild deformities.
- Non-Surgical Observation: Mild cases may improve as implants settle naturally over a few months, but this is less common.
Additional Details
- Prevalence: Double bubble is relatively rare, with an estimated 2-4% risk in breast augmentation patients, though the risk is higher in those with specific anatomical factors.
- Related Deformities: Double bubble is distinct from bottoming out (where the implant sags significantly below the inframammary fold without a second crease) and Snoopy nose/waterfall deformity (where breast tissue sags over a high-riding implant, resembling a Snoopy’s nose).
If you suspect you have a double bubble deformity, contact DeConti Plastic Surgery at 804 673-8000. Dr. DeConti can assess the condition through a physical exam and discuss with you the best method for achieving the results you desire.