A double bubble, breast deformity exists when the implant sits below the level of the normal inframammary crease. This gives the appearance of two distinct bulges or “bubbles” beneath the breast, one from the implant and one from the natural breast tissue. This can commonly occur if the surgical pocket is created too low, violating the normal inframammary crease.
It also occurs if the breast implants are too large and inadvertently violate this crucial anatomic landmark of the breast. There have been suggested non-surgical corrective techniques, which I believe universally fail.
Recently, fat grafting has been shown in a limited number of cases to achieve a result satisfactory to the patient. However, when the double bubble of the breast is very large, visible, and significant- surgery is in my opinion, the best way to correct it.
In my experience, trying to score the breast parenchyma universally does not work. If the implant is above the muscle, next repositioning it to under the muscle may work. Also, although more drastic removal of the implant for a minimum of three months and surgically with sutures repair, the violated, infra, mammary crease.
Suturing the crease to its original position, and then replacing the implants in my opinion jeopardizes the result as the replaced implant, may impinge upon the repair suture site, and disrupt it.
Therefore, repair of the double bubble, without surgery is futile in my opinion. The removal, repair of the crease, and re-augmentation- at least three months later should solve the problem
THOMAS TREVISANI, MD
BOARD-CERTIFIED PLASTIC SURGEON
MEMBER OF THE AMERICAN SOCIETY OF AESTHETIC PLASTIC SURGERY
