Frequently we see patients with double bubble breast deformities where the improper surgery was performed. Patients often need a combination augmentation/breast implant as well as a formal mastopexy in order to remove extra skin to give a normal-appearing breast because there are two problems at the same time.
The first problem is that there is a loss of volume of the breast requiring an increase of volume in the implant, saline or silicone, properly positioned and the second is a formal mastopexy to remove all the extra skin because of Grade III ptosis and that means the nipple is well below the inframammary fold at the bottom of the breast, greater than 3 cm below the inframammary fold.
Therefore, when plastic surgeons or physicians perform the wrong operation, you can expect to get, unfortunately, a poor result. Proper results requires proper surgery.
If a woman has both severe sagginess as well as loss of upper pole fullness, we like to do the combination of the implant through the periareolar and under the muscle as well as a concurrent formal breast lift which will allow for a reshaping of the breast. The implant will be placed into the proper position and the skin can then be removed, tightening up the breast to a normal shape.
Double bubble deformity occurs when a vertical lift and an implant is placed if the patient also needed skin removed from the inframammary fold. We have seen this and these patients preoperatively have a very long shape breast in the vertical plane.
Therefore, this again needs to be discussed with the patient prior to surgery. A correct breast lift, trying to reduce and limit scars on the inframammary fold, can lead to severe deformities of the breast and give an inadequate or lousy result afterwards.
Double bubble deformity is once again, as we stated, very common with the transaxillary as well as transumbilical approach. The problem with the transaxillary approach is it is quite a long distance from the axilla to the inframammary fold, especially along the parasternal region and these fibers of the pec major need to be released appropriately or the implant simply ends up too high.
Therefore, we see a significant number of patients coming in who have had transaxillary breast augmentation and the implant was just too high. Once the muscle is completely released along the parasternal and along the inframammary fold, the implant drops into the perfect position and the patient has a wonderful appearing breast.
It is quite reasonably easy to fix these; however, we recommend the patient, prior to having the breast augmentation, truly consider the periareolar approach (in my opinion the gold standard), which accurately, predictably and safely allows you to get a beautiful shape and the implant is positioned absolutely perfectly.
From the transumbilical approach, the implants often end up laterally displaced and the patient may not have the implants placed in the proper position. Also, the cleavage may be inadequate. Therefore, it is very, very important that the implants be placed in an approach that is predictable and safe, such as the periareolar approach.