Double Bubble Deformity
What is the Double Bubble deformity?
When viewed from the side, a normal breast has one smooth curve from the chest wall up to the areola (colored skin surrounding the nipple). If a breast has two curves, a double curvature or double fold, this is the so-called “Double Bubble.” Since it is not a normal shape, it is termed a “deformity.”
Causes for Double Bubble
When a breast implant is inserted, the patient’s own breast tissue and skin is stretched outward (forward, anteriorly). Often, as the skin stretches forward, a little bit of skin from the upper abdomen gets stretched upward to become the lowermost skin on the augmented breast. The fold under the augmented breast is thus a new fold. The original fold stretches and is no longer visible, having moved up onto the underside of the augmented breast. This original fold can sometimes be felt or barely seen a little above this new fold on the underside of the newly augmented breast. This creates one smooth curve on the underside of the normal appearing augmented breast. However, there are situations in which this original fold becomes visible again, causing the “Double Bubble.” This second curvature on the underside of the breast can appear soon after or years after a breast augmentation.
Early Appearance After Breast Augmentation
The Double Bubble deformity may occur soon after a breast augmentation for a variety of reasons. The original fold may not stretch enough to create a smooth lower breast curve; the implant may descend a little too far, making the original fold visible. There is a higher chance of this happening if the patient’s tissues are relaxed, or if there is significant drooping before hand and a breast lift is not performed. It can also occur if the patient’s tissues are tight, the original breast is very small, the distance between the areola and the fold under the breast is short and the skin is tight, or if the small amount of breast tissue is a narrow cone shape (tubular breast deformity). Sometimes, the way the muscle is released during the augmentation may accentuate muscle tug on the original fold and create a second curvature under the breast. Any factor alone or factors in combination can contribute to a “double bubble”.
To minimize this occurrence at the original surgery, the breast base width is measured and the implant profile is chosen so that the original breast “footprint” covers the implant entirely or as much as possible.
Delayed Appearance After Breast Augmentation
Sometimes the augmented breast looks great for years, but a Double Bubble deformity appears as the original breast tissue ages. The breast tissue may sag from the original fold (now on the undersurface of the augmented breast) and not the new fold created during breast augmentation (where the augmented breast meets the upper abdomen). Instead of a single curve under the breast, there is a second curve created by the sagging original breast tissue. Each of these two different curves is one of the “bubbles” in the “Double Bubble”.
The mildest form of a Double Bubble goes away when the patient lies down. If such a patient lifts her breasts, the skin tightens and temporarily eliminates the extra fold. The mildest form of the Double Bubble deformity may be unknown by the patient or her significant other.
Good Candidates for Revision for Double Bubble Deformity
There is no medical consequence to a Double Bubble and no increased risk for any other implant-related problem. The upper breast may have very acceptable appearance, and the patient may look great in clothing and brassieres. If the patient is not troubled significantly, then nothing needs be done. However, if patient wishes to look better undressed, then much can be done to improve the overall appearance.
During your consultation, Dr. Pertsch will determine how best to achieve your desired outcome. Patients are asked to find images of models undressed from the waist up to demonstrate their desired outcome, including their desired breast proportion, shape, and position. (Our office has over 1300 pages with multiple images to save patients time from finding images on their own.) Only when the desired end result is known can the procedure to achieve that be determined.
Procedure to Correct Double Bubble Deformity
Occasionally, a procedure to tighten the implant pocket is all that is needed (capsulorrhaphy with or without ACD reinforcement). However, other procedures are often needed, including combinations of breast lift / breast reduction with higher profile implant, neo-pocket creation, or implant pocket change from submuscular to subglandular with muscle repair. Implant removal and possible capsulorrhaphy may also eliminate the double fold, but this is rarely elected because most patients are anxious to do whatever is necessary to continue the benefit of their fuller chest size.