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DOUBLE-BUBBLE BREAST DEFORMITY
By Stuart A. Linder, M.D. | June 23, 2009
DOUBLE-BUBBLE BREAST DEFORMITY
WHAT IS IT AND HOW TO FIX IT
Dr. Linder sees patients weekly for breast revision surgery. He is licensed both in California and Nevada. He sees patients with double-bubble breast deformities quite frequently. The etiology of a double-bubble deformity can be multifaceted. Most commonly, it is associated with simply malposition of the implants (where the implant is too high, superiorly retropositioned) and scar tissue forms along the inframammary fold and pushes the implant up. This can occur due to malposition associated with the original surgery in which the implant was placed in improper pocket. In other words, the parasternal and the inframammary lateral attachments of the pectoralis major muscles were not released, which does not allow the implant to fall into its normal pocket. Last week, I had patients in from Phoenix, Arizona as well as San Diego for this operation. In both cases, the implants could not lower into its normal position due to the muscle not being released correctly along the parasternal inframammary fold. So, the most common cause is malposition associated with implant placement from the original surgery.
Textured implants may also create a double-bubble deformity in that the implant will adhere like Velcro into the improper position in a superior position and cannot fall even if the pocket inferiorly along the bottom is open. These textured implants are removed and smooth salines can help with this problem. Often, the patients will have double-bubble deformity with ptosis in which the surgeon attempted to do a round block or a nipple areolar lift, but did not remove skin vertically along the inframammary fold, which leads to a double-bubble deformity and a grade 3 ptosis with skin over-drape. This is usually corrected by formal mastopexy using the inferior pedicle Wise-pattern technique or Wise anchor scar technique.
The way that I fixed both of the above-mentioned specific surgeries was by removing textured implants, performing an open capsulectomy both superiorly as well as an inferior open capsulotomy along the base, completely releasing the thick and hard scar tissue, as well as the muscle attachments of the pectoralis major along the parasternal and along the lateral inframammary fold. This then allowed the new smooth saline implant to drop and then sitting the patient up, remarking the Wise-pattern or anchor pattern, repositioning the nipple areolar complex superior, removing the skin vertically as well as along the inframammary fold. In order to fix a double-bubble deformity, the correct surgery must be performed, which will require releasing the pectoralis major muscle appropriately which may not be performed through transumbilical or transaxillary approaches during its original surgery.
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