What is a “double bubble”? Plus other cosmetic deformities after breast implant surgery

Published June 25, 2023 by
Woman with breast implants after Las Vegas breast augmentation

It’s safe to say that all my breast surgery patients envision themselves with beautiful, symmetrical contours they’re proud of. That’s certainly my goal for you, and as it has been for all my patients in my 17+ years (and counting!) as a Las Vegas cosmetic surgeon.

However, the reality is that a small number of breast augmentation patients will experience less than desirable results months or even years down the road. I’d rather you know about these now, because a number of the problems I’m about to discuss can be altogether avoided with smart choices.

So whether you have concerns about your own breast implants, or you simply want to be a more informed patient as you begin your journey, read on.

Bottoming out: when breast implants sit too low

During breast augmentation surgery, the implants are placed so that they sit a little high on the chest. This is intentional, as both the implants and breast tissue are meant to relax and stretch into a natural position (a.k.a. “drop and fluff”) during the recovery process. Most of the time, this is exactly what happens. On occasion, however, the implants settle too low with a disproportionate amount of fullness in the lower breast, resulting in nipples that sit too high. This is referred to as bottoming out. 

Most instances of bottoming out are caused either by implants that are too large or too heavy for the person’s tissues (skin, breast tissue, and muscle) to hold up, or tissue that is already too weak or stretched out. Stretch marks can be a sign that this is the case. Bottoming out can occur with or without a double bubble (see below) and affect one or both breasts.

Repairing bottoming out issues

Techniques I use to repair bottoming out include reconstructing the crease of connective tissue beneath the breast called the inframammary fold, and removing and replacing the breast implants (with the same or a smaller size, if appropriate) so that the breast and implant are better supported, resulting in better integration and natural-looking contours. Many times this includes using a surgical mesh such as Galaflex to create an internal bra to help the tissues support the implant over time.

Double bubble: when one breast seems like two

When the breast tissue mound is very defined and smaller than the implant being placed, and the implant extends beyond the margins of the breast mound, the breast can take on the appearance of a double layered cake or “double bubble.” The double bubble is when the margins of the implant extend beyond the breast mound (bottom bubble) and the breast mound on top (top bubble) doesn’t stretch out to the margins of the implant. 

If the breast implant itself sags below the inframammary fold, this can result in the appearance of bulge pushing out from underneath and is also more likely in patients with a short distance from the nipple to the inframammary fold as well as those with tuberous breasts.  

Repairing double bubble complications

Since this issue can occur when the implant is placed under the muscle, it is corrected with a breast implant revision procedure that involves moving the implant to the above-the-muscle position.

When the implant is sagging below the inframammary fold, I will typically reconstruct the fold so that it better supports the implant, often using Galaflex mesh to reinforce the tissue and protect against recurrence of the double bubble.

Gland ptosis: when breasts sag around the implant

If the breast tissue drops lower than the implant, the implant will appear to push out of the top part of the breast and the nipple will sit too low. This is called glandular ptosis (or sagging) from an implant. 

This situation may be caused by aging, weight changes, pregnancy-related breast changes, or may be the result of another complication called capsular contracture, where the tissue surrounding the implant tightens. 

Addressing gland ptosis

Gland ptosis caused by tissue sagging can often be treated with a breast lift, along with repositioning the breast implant. If capsular contracture is present, however, it is corrected with a capsulectomy, or removal of the scar tissue capsule, and mesh.

The single most important thing you can do to minimize the risk of complications and get the results you want is to choose a very experienced cosmetic surgeon with a reputation for producing excellent breast augmentation results.

Synmastia, a.k.a bread loafing

Another issue I treat in some Las Vegas breast implant revision patients is synmastia, also known as “symmastia,” “bread loafing,” or “uniboob.” As you may have guessed, this happens when the breasts sit too close together at the center of the chest, usually as a result of one of these scenarios:

  • The implant pockets were made too close to the center during surgery.
  • Implants were squeezed towards the midline in the early healing period by the patient or external forces (i.e. a bra).
  • In patients with a floating cleavage, where the skin is not adherent to the sternum, and afterwards appears to float more so than it did without implants. (This last category may appear as synmastia prior to implants being placed.)

In more severe cases, the implants will push the skin between the breasts up at the sternum, creating the appearance of a single breast with a saddle in between, instead of two separate breasts. 

Correcting synmastia

Treatment for synmastia typically involves securing the middle tissues along the sternum with a mesh such as Galaflex, repositioning the implants, and moving to smaller implants. As with any breast implant complication, correction requires a considered and refined approach, making it critical to work with a cosmetic surgeon who has extensive experience in correcting synmastia.

Implant rippling

Visible implant edges, wrinkling, or rippling may arise after breast augmentation. Rippling can occur in several different scenarios:

  • When there is too little natural breast tissue covering the implant
  • If the breast implant pocket is too big or too small
  • If the implant is too big or heavy for the person
  • When the person leans forward (top of implant) or lays down (outsides of implant)
  • If a saline implant is under- or over-filled per the manufacturer’s specifications

Most of these causes are based on your anatomy: the less tissue covering you have, the more likely you are to see wrinkling and rippling.

Options for correcting rippling and similar issues

Rippling can be improved in a few ways. In some patients, a fat transfer can mask the areas of rippling and wrinkling by thickening the tissue layers covering the implant. More often, breast implant revision is necessary to modify the breast pocket size, tissue thickness, fill volume, or (if needed) to replace the implants with a more appropriate size.

Breast animation deformity

Breast implants are often placed subpectorally, so that the upper portion of the implant sits partially or fully beneath the chest muscle. This technique helps to conceal the implant edges and reduces the risk of visible rippling, and generally achieves a more natural looking result. However, some women with subpectorally placed implants will notice that their breasts change shape when they contract their chest muscles. This is called breast animation deformity and is most noticeable in those who have highly developed chest muscles. (This shows the importance of taking a patient’s lifestyle into account when planning breast augmentation.)

Options for treating breast animation deformity

Treatment involves relocating the implant to sit above the muscle. Whether or not to treat breast animation deformity depends on how bothersome it is to you. This tends to be more noticeable in active women such as bodybuilders, but can affect anyone with subpectoral implants. 

What can I do to avoid these breast implant complications? 

The single most important thing you can do to minimize the risk of complications and get the results you want is to choose a very experienced cosmetic surgeon with a reputation for producing excellent breast augmentation results. Check their patient reviews, look at their before and after photos for patients like you, and ask lots of questions. 

Achieving and maintaining a great result is also up to you. Listen to your cosmetic surgeon’s advice and choose an implant size and placement that’s appropriate for your body, versus seeking out a surgeon willing to risk placing inadvisably large implants. Don’t smoke, as this can slow healing and compromise your skin elasticity over time. Know that significant weight loss or gain can affect how your breasts look, even with implants. Finally, if you have any concerns about your breast implants, reach out to your cosmetic surgeon.

If you’re considering your options for breast augmentation in Las Vegas, or need an experienced breast revision surgeon to improve or repair your breast augmentation results, I invite you to contact my office for a consultation. I’ll be happy to answer your questions and help you achieve the look you want.

Leave a Comment: