Double-bubble is a term used to describe a deformity where there is a crease across the lower part of the augmented breast or the breast tissue appears to be “falling off” of the implant. In either situation, it creates an unattractive breast with two distinct breast mounds, thus the term “double-bubble.”
Double-bubble often occurs as a result of the previous inframammary fold indenting the lower pole of the breast following breast augmentation. It is common in patients with constricted (tight) lower breasts, those with very sharply defined natural breast creases, and those with a short nipple to inframammary fold distance. In these cases, the deformity can become obvious if the breast implant extends below the natural breast fold.
Another common cause of double-bubble is when the breast implant remains in a high or even normal position, but the breast tissue and nipple sags downward. This can be seen in patients with sub-pectoral implants or capsular contracture that holds the implant up but allows the breast tissue to descend. This can occur immediately after surgery or over time as a result of pregnancy, weight change, or gravity.
The treatment of double-bubble depends on the cause and the severity of the deformity. While some mild cases may improve without surgery, many will require surgical correction. In cases where the previous inframammary fold indents the lower breast, surgery is often performed to revise the breast pocket and to score (cut) the breast fold. Some cases benefit from changing from sub-pectoral to sub-glandular implant position or by changing implant size. In cases where the breast tissue is hanging off of the breast implant, a breast lift (mastopexy) may be required. If capsular contracture is responsible for the deformity, a capsulectomy and breast implant exchange may correct the problem.
As with many breast deformity cases, double-bubble correction is a challenging yet extremely rewarding type of revision breast surgery performed frequently by Dr. Ciaravino.