Double Bubble – A Breast Augmentation Complication

Reviewed by Walter Erhardt, MD

"Double bubble" is a descriptive term for a postsurgical complication that can occur after breast augmentation with breast implants. Specifically, double bubble happens when an implant drops down behind the natural fold (inframammary crease) where the lower breast meets the chest, rather than forward into the breast. This shifting creates an unnatural indentation or line across the bottom (lower pole) of the breast; this is particularly visible when the arms are lifted above the head. When viewed in profile, double bubble is said to have a "four-breast effect."

Fortunately, double bubble is a relatively rare complication that is correctable in most cases.

Causes of Double Bubble

There are several scenarios that can result in double bubble, including improper breast implant placement. Double bubble occurs most often in women with sagging breasts whose implants were placed under the chest (pectoral) muscles. (This placement is known as submuscular, and the implants are referred to as "unders.") The breast tissue hangs low enough to look like one set of breasts. The implants look like another.

double bubble breast augmentation

The risk of this occurring may be reduced by placing the breast implants over the muscle. (This is known as a subglandular placement, and the implants are referred to as "overs.") Alternatively, the surgeon may recommend that the woman have both a breast augmentation and a breast lift.

Double bubble can also happen after pregnancy. This occurs when breast tissue droops from the excess weight gained during pregnancy, but the implants remain where they were originally placed.

Also at high risk are women who have limited lower breast skin, or a short distance between the bottom of the areola (dark skin around the nipple) and the breast crease.

Another contributing factor for double bubble is breast augmentation capsular contracture. This occurs when scar tissue tightens around the implant, causing aesthetic and physical problems.

Capsular contracture occurs most often during the first two years following breast augmentation recovery.

Double bubble can also occur when:

  • Implants are too big (heavy) for the chest wall and cause the supporting tissues to stretch, settle or migrate below the inframammary crease
  • Implants are poorly positioned by the surgeon
  • The mammary crease is constricted
  • The woman has tuberous breasts
  • Scarring is present from previous breast surgeries

Double bubble can develop at almost any time after breast augmentation surgery. If you develop this complication, consult with your surgeon. Remedies do exist.

Correcting Double Bubble

There are several ways to correct double bubble, all of which involve surgical intervention.

One option is revision breast augmentation surgery involving a breast lift (mastopexy) and submuscular placement of the implants.

Another corrective action for double bubble involves removing the implants and placing new ones in front of the muscle. This placement can fill out sagging skin, but rippling may occur.

Alternatively, the breast crease can be modified. A small incision is made in the crease, which is then tightened and raised by placing sutures along the bottom of the breast. This eases the implant back into its proper position.

The right double bubble correction for your situation should be determined during a consultation with your original plastic surgeon. If your breast augmentation was recent (within the past six months), your surgeon may advise a "wait and see" approach to determine if it improves on its own. If you're farther out from your original surgery date, you may need revision surgery. Depending on your surgeon's revision policy, you may not have to pay his or her surgical fee, although you will still be responsible for the anesthesia and facility fees.

Alternatively, you can choose another qualified plastic surgeon to perform the revision. Be sure that he or she is a board certified plastic surgeon who has extensive experience performing double bubble surgery and breast augmentation revision. Start your search for the right surgeon now.