Double Bubble

A “double bubble” effect is a specific type of implant malposition after breast augmentation. It occurs when the implant descends below the original inframammary crease and the remaining breast tissue lays on top of the implant. The original inframammary crease creates an unnatural depression or line overlying the implant on the lower third of the breast. This gives the illusion of a “double bubble”.

A double bubble is more common in the following instances:

  • Selecting implants that are too heavy for the chest wall tissues to support, tadalafil leading the tissues to stretch, and the implants to migrate below a tight inframammary crease
  • Women with ptotic or sagging breasts
  • Pregnancy causing loss of volume and sagging
  • Submuscular implant placement
  • Capsular contracture
  • Constricted or tight inframammary crease
  • Tuberous breast deformity
  • Scarring from previous breast surgeries
  • Poorly positioned implant during initial procedure
  • Overly dissected pocket during initial procedure

The best way to avoid developing this complication is to select an implant size that fits your chest width and nipple-to-inframammary crease distance. If the breast is ptotic and sagging, then a breast lift or mastopexy should be performed.

There are several options for correcting a double bubble.

  • If the implants are low in relation to the nipples, the inframammary crease is reconstructed with internal tissue; the rectus fascia and implant capsule. This creates a new inframammary crease to support the implants. Some surgeons may use acellular dermal matrix, i.e. Alloderm, for this repair. The superior portion of the capsule is opened to allow the implants to be moved superiorly without undo tension pushing them down. Drains are usually required to drain the dead space which is left when the implants are lifted to their new position.
  • If the patient has breast ptosis or sagging, then a breast lift, mastopexy, will be performed.
  • Rarely, the implants will be moved from behind the muscle, submuscular position, to just under the breast tissue, subglandular position. The implants will then stretch the skin causing the unnatural depression or line to vanish. The problem with this technique is the remaining skin and tissue are usually not strong enough to support the implants, leading to inferior displacement of the implants over time.
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