Although breast augmentation is conceptually not very complicated—find the right size and shape of implant, place it in just the right position behind the breast—a lot of things have to come together in just the right ways in order for the final result to be ideal. One problem that occasionally occurs even with very experienced surgeons is the “double bubble,” a sort of double curve of the lower part of the breast. It can be challenging to correct but fortunately there are some newer techniques which can be very helpful.
One problem is that there is more than one cause to the dreaded double bubble. One is where the inframammary fold, the bottom edge of the breast, is very high; this results in a very short distance between the nipple and the bottom of the breast. So in order to center the implant appropriately, the fold must be lowered or the implant rides much too high. When the bottom edge of the breast is reset in order to follow the outline of the implant, the original fold may cause a tight band across the mid-portion of the bottom half of the breast.
I have identified another cause of the double bubble though. This one is a bit sneakier, occurring in breasts that don’t look like they would have this sort of issue. In order to understand it, we need to consider one very important aspect to submuscular implant placement: using the standard (dual-plane) technique, the pectoral muscle is cut where it attaches to the ribs. (This is necessary for implant positioning in most cases.) The cut edge of the muscle then resides in front of the implant, where it heals into the scar capsule as it forms. The point of attachment is typically about halfway between the bottom of the breast and the nipple, exactly where the indentation of the double bubble is seen. In these cases, it is the muscle exerting traction on the capsule that is the cause.
Fortunately, there is a solution. If the muscle is split rather than cut, the upper part can be used to cover the upper portion of the implant, while the lower part remains behind the implant. With this technique, all of its attachments remain intact. This gives muscle coverage where it is most needed while avoiding many of the problems with the traditional technique. This split muscle technique has become my most common approach and is also useful for correcting existing problems.
See examples of corrective procedures from Dr. Baxter below: