Q: Dr. Eppley, I had breast augmentation using silicone gel implants one month ago. The implants were placed through an incision underneath. Ever since surgery, my left has an indentation about halfway up from the bottom. It is an actual deep crease and it looks like two bulges. The other breast is perfectly smooth. My surgeon said it should go away and, if not, I will need another surgery to fix it. (ugh!) Can you explain to me why this happened?
A: The ‘double bubble’ problem after breast augmentation is not a rare phenomenon. It is the result of changing or lowering one’s existing inframammary or lower breast fold. This is often necessary to accommodate the size of a breast implant and to prevent too high of an implant position, resulting in excessive upper breast pole fullness.
What many women do not realize is that much of the work or volume addition that a breast implant does involves expansion of the lower pole and sides of the breast. While every breast is different, about 1/2 to 2/3s of breast size increase involves these breast areas. These means that the breast base size in a vertical dimension must change. When the breast is smaller, the inframammary fold or crease is higher because the existing volume only needs a certain amount of skin between the nipple and the fold to accommodate it. When an implant is added that dramatically changes the volume, not all is just needs to be pushed outward. Some of that volume needs to expand the breast mound lower. For this reason, the augmented breast may require dropping the position of that fold.
Because the inframammary fold has been in its present position for years, the skin has an indentation or crease in its basic structure. When the fold is lowered to accommodate an implant, that crease can take some time to relax and go away. In many cases it will but in others it will not…thus creating the double bubble problem. This is why plastic surgeons do not like to drop the lower breast fold unless they absolutely have no choice but to do so.
If the double bubble problem fails to resolve itself by three months to six months after surgery, then it will require a surgical procedure for correction. This involves tacking back down the fold into its original position and raising the implant slightly.
Dr. Barry Eppley