If you're a woman who's been considering breast augmentation surgery, then you may have heard of something called a double bubble deformity. But what is it, and is it something you need to worry about? In this post, we'll explain everything you need to know about double bubble breast implants. Keep reading to learn more.
What is a Double Bubble Breast Implant Deformity?
A double bubble breast deformity, also known as a double bubble breast, is one possible complication that can occur from a previous breast augmentation surgery. It happens in patients when the breast implants don't align perfectly with the lower breast tissue, creating an indentation or bulge in the lower pole of the breasts (the part of the breast below the areolas). The normal fold where the bottom of your breast meets your lower chest is called the inframammary crease. In women who have a double bubble, there will appear to be a second crease either above or beneath the natural fold.
What causes a double bubble breast to form?
There are two distinct types of double bubble deformity and they can occur individually or in combination following breast augmentation. The two types are distinguished by what causes the extra crease underneath the breast. It's critical for your plastic surgeon to diagnose your double bubble type correctly because each one requires that he or she perform a different surgical correction.
Type 1 - Incorrect Implant Position
In a Type 1 double bubble deformity, the bottom of your breast implant descends below your natural inframammary crease. This creates a second, false crease lower down on the chest and the real crease runs higher up across the lower pole of the breast somewhere between the bottom of the implant and the nipple.
What might lead to a Type 1 double bubble? In other words what makes the breast implant pocket drop beneath the natural breast crease? Several factors can raise the risk:
- Weak Inframammary Crease - and some women, the inframammary crease is very poorly defined and almost nonexistent. This weak crease can provide inadequate support for the implant and ultimately give way leading the implant to drop.
- Constricted Breasts - A constricted breast (or tubular breast deformity) has a shorter-than-average distance of skin from the inframammary fold to the nipple. When the newly placed implants pull on this already tight skin, they can lift the inframammary crease off its attachment to the chest wall allowing movement of the implants beneath the fold.
- Overly Large Implants - Even in patients with normal lower pole breast tissue (without constricted breasts), placement of excessively large implants can produce a double bubble. The excess implant volume has to go somewhere and it can force its way downward stretching the pocket below the inframammary crease and leading to a double bubble deformity.
- Surgical Technique - In a patient with tight lower breasts or one wanting large implants, the plastic surgeon might intentionally release the inframammary crease to shape the breasts and allow better implant positioning. Though the crease can be lowered a small distance, this maneuver can be risky and a double bubble may occur if too much support for the implants is lost.
Type 2 - Sagging Tissue (Breast Ptosis)
A Type 2 double bubble deformity occurs when the bottom of your breast tissue (not the implant) descends over the implant. The implants are in their correct position relative to the crease, but drooping breast tissue creates a second false crease lower. In these patients, the false crease crosses the lower breast somewhere above the natural crease. This type of double bubble is less common than a Type 1 but it may occur in combination with it.
Type 2 double bubbles can develop immediately after surgery or they may appear months to years later as a result of natural changes that occur with aging. Pregnancy, weight gain, and weight loss can all contribute to the development of this type of double bubble. The common factor in Type 2 double bubble is a breast implant placed behind an excessively sagging breast.
It is true that patients with small amounts of sagging are often corrected with just breast augmentation procedures. But when a plastic surgeon tries to treat more than minor sagging without a mastopexy (breast lift), it can lead to a double bubble breast deformity. Lacking enough internal support, the patient's natural breast tissue slides down over the implant that sits behind it. The false crease appears at the bottom of the fallen breast tissue and is above the position of the real inframammary crease.
You may be surprised to learn that the appearance of Type 2 double bubbles is more likely in patients with smaller sagging breasts than in those with larger breasts. That's because fuller breasts creates more padding over the implant. The false inframammary crease remains hidden beneath the thicker natural breast tissue.
One other variation of a Type 2 double bubble happens when a capsular contracture develops after breast implant surgery. A capsular contracture is a thickening and tightening of scar tissue surrounding the breast implant. This tight scarring typically pushes the implant upward. The result is a false crease at the bottom of the breast that appears similar to a Type 2 double bubble deformity. Here, the breast tissue is in the correct place but the high position of the implant creates the appearance of sagging. The lower breast tissue draping beneath the implant creates a false inframammary crease above the real crease.
How do you know if you have a Double Bubble Breast Implant?
For the typical plastic surgery patient, knowing whether or not you have a double bubble following breast augmentation isn't hard. If you have two creases on the underside of your breast implants with a second bulge or bubble in between them, you likely have a double bubble.
Determining whether you have a Type 1 or Type 2 double bubble can be trickier and will likely have to be done in consultation with a plastic surgeon, ideally one with experience in the treatment of this complication.
What are the symptoms of a Double Bubble Breast Implant?
The most obvious symptom of a double bubble is the appearance of two creases on the underside of your breast with a second bulge or bubble in between them. Without this finding, you don't have this breast deformity. And remember, a true double bubble can only result from a previous breast augmentation procedure.
Other symptoms may include:
- Pain in the affected breast
- Asymmetry of the breasts
- Hardening of one or both breasts (if a capsular contracture is present)
- Too much or too little upper breast fullness
How is a Double Bubble Breast Implant Treated?
The only way to treat a double bubble is through plastic surgery. The specific type of revision surgery required will depend on several factors, most notably the type of double bubble you have and its underlying cause. Any revision following breast augmentation must be thoughtfully planned and requires detailed consultation with your plastic surgeon.
Type 1 Double Bubble
A Type 1 double bubble can often be treated with a capsulorrhaphy, also known as a capsular repair. This is a relatively minor surgical procedure that involves tightening the scar tissue around the implant by closing part of the lower implant pocket with sutures. This treatment forces the implant upward so it sits in the correct position with its bottom at the inframammary crease.
Some plastic surgeons like to add support for this correction by reinforcing it with a sling of synthetic mesh. Though mesh placement makes sense in correcting some double bubble implants, we believe it is overused. Artificial mesh is expensive, rarely provides reliable support, and can cause more scarring and other complications.
If extra support is needed, we prefer to use a technique in which we make a sling out of your own scar capsule tissue. This treatment more reliably reinforces the implant position without adding additional supply costs.
If the patient has a short distance from the nipple to the natural breast crease (or if an overly large implant was used at the previous breast augmentation), changing to a smaller size may be necessary to reliably restore the correct fold position.
Type 2 Double Bubble
A Type 2 double bubble typically occurs when breast augmentation alone is done on a patient who needs both implants and a mastopexy. This makes the correcting procedure obvious; the revision surgery is to do the breast lift procedure that was needed in the first place. Usually, the amount of lift needed is small. Raising the nipple to the correct position and removing the excess lower breast skin is usually enough to fix this complication. In our experience, a vertical (lollipop) mastopexy, and sometimes even a mini breast lift (donut or Benelli procedure) is all that is needed to restore the breasts' appearance. The full anchor mastopexy is rarely necessary and we avoid additional scarring along the inframammary fold.
If the double bubble is from a capsular contracture, the treatment is a partial or total capsulectomy (removal of scar tissue). This allows the implant to drop to the inframammary fold eliminating the double bubble.
Some double bubbles have more than one cause. These patients will need a combination of the procedures we've discussed to correct their more complex breast deformity.
What are the risks associated with treating a Double Bubble Breast Implant?
Correcting a double bubble typically requires additional plastic surgery and carries with it all the usual risks of surgery under general anesthesia (such as bleeding, scarring, and infection).
But the most important potential complication of double bubble surgery is a partial or total reappearance of the double bubble. This can happen if the underlying cause of the problem is not fully addressed or if the wrong type of operation is performed. For example, a Type 1 double bubble caused by a breast implant that's too large for the patient has a higher risk of recurring unless the size of the implant is reduced.
Even if the double bubble type type is correctly diagnosed and the revision surgery is performed correctly, the double bubble deformity may still return. Though the risk of a recurrent double bubble isn't high, the plastic surgery to fix it may be more complex. In addition to repairing the fold, performing a breast lift, or treatment of a capsular contracture, the patient may require temporary removal of the breast implant to allow complete healing of the area. The implant can usually be replaced with a breast augmentation three to six months after the initial removal.
What are some of the best ways to prevent or reduce the risk of developing a double bubble deformity after breast augmentation surgery?
The best way to prevent a double bubble from happening in the first place is by choosing an experienced, board certified plastic surgeon who regularly performs breast augmentation and has significant experience with revision breast surgery. Your surgeon should also be willing to spend time discussing your aesthetic goals and answering all of your questions.
This is especially important for patients with anatomical issues that are more likely to lead to a double bubble deformity from breast augmentation. These problems would include:
- A poorly defined breast crease or inframammary fold.
- Sagging skin and low nipple position especially in patients with B to C cup breasts.
- A desire for implants that are very large in comparison to your chest.
How Much Does Double Bubble Breast Implant Correction Surgery Cost?
The cost of double bubble breast implant correction surgery will vary depending on the complexity of the case, the type of revision surgery required, and whether one or both breasts need to be treated. Most of our double bubble surgeries cost between $5,500 and $14,000.
This includes the surgeon's fee, anesthesia fees, operating room costs, and postoperative care. It's important to note that some revision surgeries will require more than one procedure to correct the problem. In these cases, the total cost or treatment will be higher.
Summary
Even though a double bubble breast implant deformity is not very common, it can be extremely frustrating and distressing for the women who experience it. If you are concerned that you may have this condition, please schedule a consultation with us. We will evaluate your implants and advise you on the best treatment. In most cases, we are able to achieve excellent results with revision surgery. So don’t despair – there is hope! Give us a call or text today to set up an appointment.
