The term “double bubble” breast deformity is a notable complication following breast augmentation surgery. It creates the appearance of two creases or “bubbles” on the lower part of the breast. One from the natural inframammary fold (IMF) and another from where the implant pocket settles.
What Is Double Bubble?
A “double bubble” occurs when breast implants, especially submuscular ones, descend below the original IMF. This results in two distinct folds: one of the natural breast tissue and the other by the implant positioning. This gives the illusion of two separate “bubbles” on each poles of the breasts.
Visually, it’s most noticeable when the arms are raised or during certain movements. Sometimes they resemble four small mounds — a medical photo series has even nicknamed it the “four‑breast effect”.
Causes of Double Bubble
- Disruption or detachment of the inframammary fold. If, during breast augmentation procedure, the fold is separated from the chest wall, the implant lacks proper support. It may slip below, forming a secondary crease.
- Mismatched implant size/shape. Oversized or overly wide implants can force a new fold to form beneath the breast as tissue fails to stretch adequately.
- Anatomical predispositions. Conditions like tuberous breasts (high natural fold, narrow base) or a short nipple-to-fold distance increase susceptibility.
- Capsular contracture or scarring. Tight capsule formation during plastic surgery can pull the implant into awkward positions.
- Submuscular placement in ptotic breasts. Breast tissue droops beneath the muscle while implants remain higher, creating visible separation.
How do you recognize the deformity?
Although the risk of developing a double-bubble deformity after breast augmentation is relatively low, it is not negligible. This risk is particularly high in patients with certain anatomical factors or if the surgical technique is suboptimal. Overall, the risk is estimated at 2–5% of breast augmentation patients. However, this figure increases significantly (up to 15–20%) in patients with constricted breasts or significant breast sagging (ptosis).
The double bubble breast implant deformity can be recognised by observing a few key visual and physical signs.
Visual Signs
- Two horizontal creases under each breast: One is the natural inframammary fold (IMF). The second is a new, lower crease created by the implant dropping below the original fold. These can appear as two separate “bubbles,” hence the name.
- Ripple or bulge beneath the breast: The lower part of the breast may appear distorted or oddly shaped. It may look like there’s a second smaller breast mound beneath the main one.
- Breast asymmetry or uneven contour: One breast might appear lower, flatter, or double-crested compared to the other.
- More pronounced when raising arms: When lifting the arms, the dual folds become more obvious. This can accentuate the “four-breast” illusion — two ridges per side.
Physical Symptoms
- Palpable ridge or step-off: You might feel a separation or dip between the two folds.
- Implant malposition: The implant may sit lower than expected, or feel like it’s sliding.
- Tightness or discomfort: Particularly if capsular contracture is also present.
Not all fold irregularities are ‘double bubble’. Some might be caused by normal swelling, or by capsular contracture or animation deformity. Book a consultation with a board certified plastic surgeon at Cosmedica Aesthetic to learn more.
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Treatment & Revision Options
When a double bubble emerges, typical corrective options include:
- Revision surgery: Adjusting the IMF, resizing implants, or switching implant planes (e.g., subglandular vs submuscular)
- Breast lift in Turkey (mastopexy): To correct sagging tissue and reposition the natural fold
- Fat grafting: A minimally invasive method where fat is injected below the old fold to smooth the contour.
- Barbed suture fixation: A quick (10-minute) outpatient technique to recreate and secure the IMF
Conclusion
The “double bubble” deformity can be treated easily with surgery, implants, fat grafting or IMF restructuring. We can reduce the risk of surgery by thinking about how patients are built and using special methods like dual-plane placement and barbed sutures.
Cosmedica Aesthetic in Istanbul offers excellent care with experienced surgeons, clear pricing and great support for patients. If you’re thinking about getting your breasts done, or correcting the double bubble, you could consider their special approach and skilled team.
Patient Guidance: Q&A
Can a double bubble correct itself?
Small cases may be settled within months as the swelling goes down. But if a fold is in the wrong place, you usually need to do surgery or grafting to fix it.