If you’ve had breast implants and noticed a strange second crease running across the lower part of your breast, you’re probably looking at what surgeons call a double bubble. It’s one of the more common questions I get asked after breast augmentation, so let’s go through what it actually is, why it happens, and, most importantly, what can be done about it.
What is a breast implant double bubble?
Every breast has a natural fold underneath it, called the inframammary fold. It’s the crease where your breast meets your chest.
When an implant is placed, that old fold can cause trouble in one of two ways. Either it wasn’t fully released during surgery, or it was released but has reattached afterwards. Either way, the result is the same: you end up with two visible folds instead of one, the implant’s new lower edge, plus the ghost of your original crease running across it. Two folds, two curves. Hence the name double bubble.
It’s a cosmetic issue, not a medical one. It won’t make you sick and it isn’t dangerous. But it doesn’t look great, and understandably most women want it dealt with. Some have a subtle version, some have quite an obvious one.
What causes a double bubble?
Implant placement plays a big role. You see double bubble most frequently with implants placed completely under the muscle, because with that approach the surgeon doesn’t go above the muscle to break the old fold down, so it’s still there, ready to show through.
With dual plane placement, the surgeon does release that fold, and the muscle rides up slightly, letting the pressure of the implant push the inframammary fold out. You still see the occasional double bubble with dual plane, but it usually settles with massage.
What about implants above the muscle? Some surgeons say double bubble never happens there. I’ve seen it. And when you go back and study those patients’ pre-op photos, you often find they had a subtle natural double crease all along, two folds before surgery that may simply have been missed at the initial assessment.
Double bubble vs window shading, they’re not the same thing
These two get confused all the time. Here’s the difference: Double bubble is there at rest. Two folds, visible all the time. Window shading (also called animation deformity) only appears when the muscle contracts, put your hands on your hips, push in, and a temporary double-bubble-like distortion appears as the muscle pulls on the implant. Relax, and it’s gone.
If your crease is there when you’re standing still and relaxed, it’s a double bubble. If it only appears when you flex, it’s window shading.
How do I check if I have a double bubble?
A simple test: lift your arms above your head in front of a mirror. Raising the arms often reveals a subtle double bubble, or makes an existing one more obvious. Plenty of women first notice it in the shower, lifting an arm to shave under the armpit and spotting a crease they hadn’t seen before.
If you’re not sure what you’re looking at, a quick review with your surgeon will settle it.
Can a double bubble be prevented?
Prevention is the main game, and it comes down to careful measuring before surgery.
The key measurement is the distance from the nipple to the crease. If the implant chosen fits within that measurement, and fits the width of your chest, the risk drops significantly. My old saying applies here: get the implant to fit. Fit the width, fit the nipple-to-crease distance.
The catch is that this isn’t always possible when a patient wants a bigger implant than her natural measurements comfortably allow. That’s a conversation worth having honestly at consultation, because going well past the fold to accommodate size is exactly how double bubbles get made.
How is a double bubble treated?
There’s a ladder of options, starting gentle and getting more involved.
First: massage and strapping. Caught early, many double bubbles respond to firm massage and pressure. Strapping across the top of the implant pushes it down against the old fold, helping to stretch and break it up. This works surprisingly often, especially with dual plane implants.
Second: fat transfer and ultrasonic release. If massage doesn’t do it, a less aggressive surgical option is to pass a VASER ultrasonic liposuction probe across the old fold to break up the scar tissue, essentially tearing that stuck-down crease free so it can’t reattach, and then place fat transfer across the area to pad out the dent. I’ve done this a number of times and it’s worked very well. It’s a clever middle-ground fix that avoids reopening the implant pocket.
Third: revision surgery. The most direct fix is to re-operate, lift the crease and release it with a diathermy probe from the inside. It works, but I’d rather avoid it where possible, any time you go back into a breast implant pocket there’s a fresh set of risks, so it’s the last rung on the ladder, not the first.
Frequently asked questions
- Is a double bubble dangerous? No. It’s purely cosmetic. It doesn’t affect your health or the safety of your implant, it just doesn’t look ideal.
- Will a double bubble go away on its own? Sometimes, especially early on. Massage and strapping in the weeks after surgery encourage the old fold to release. If it’s still there months later, it usually needs treatment.
- Which implant placement has the highest double bubble risk? Fully submuscular (completely under the muscle) placement, because the natural fold isn’t broken down during surgery. Dual plane placement releases the fold and carries a lower risk.
- Can you fix a double bubble without redoing the implant surgery? Often, yes. Massage and strapping first; if that fails, breaking up the old crease with an ultrasonic probe plus fat transfer to smooth the dent has worked very well in my hands.
- How is double bubble different from window shading? A double bubble is visible at rest. Window shading only appears when the chest muscle contracts and disappears when you relax.
- How do surgeons prevent double bubble? By measuring the nipple-to-crease distance and chest width, and choosing an implant that fits those measurements rather than oversizing.
Double bubble used to be pretty common, and while better techniques have made it less so, it still turns up. If you’ve noticed a second crease after your augmentation, or you’re planning surgery and want to avoid one, come and see us. More information at absolutecosmetic.com.au.
Dr Glenn Murray, Absolute Cosmetic
All surgery carries risk. Individual results vary. Seek a second opinion from an appropriately qualified health practitioner before proceeding.
