“Double folds” after augmentation mammoplasty

What it is

Double bubble – translated from English means double breasts. In the first paragraph it was stated that this is a specific complication, so the following definition can be given.

This is a complication after breast augmentation using low-quality implants, resulting in breast deformation in the form of a double fold or double bubble.

Double bubble after mammoplasty is a general surgical complication and quite rarely develops after breast surgery.

Photo: Double breast

A double fold is a breast deformation that occurs after breast replacement when the implant and bust cannot form a single whole and, as a result, the implant acts as an additional roundness.

Consequences of mammoplasty

Plastic surgeries often lead to necrosis of the skin. As a result of gravity, the implant exerts strong pressure directly on the skin of the mammary glands. Blood supply is disrupted and necrosis occurs. The process can last 2–3 months, or it can last up to 5 years. The consequences of breast augmentation can be eliminated through additional surgery and insertion of an implant under the pectoral muscle.

When breasts are enlarged through plastic surgery, the nipples may lose sensitivity. This is due to the fact that a nerve was affected during the operation. Often sensitivity is restored after some time.

Complications after breast augmentation occur when sensitivity is not restored for a long time or when a woman has had her breasts enlarged, hypersensitivity appears that was not there before.

Among the complications of mammoplasty are those that not only affect your well-being, but also significantly worsen the appearance of your breasts. Some problems are rare, but the more questions they raise. One of the complications that mammoplasty provokes is the double bubble. Women expect after surgery a result that is by no means the same as that found when the defect develops.

Read in this article

Features of the female breast

The mammary gland is a paired organ that consists of glandular tissue.

The mammary gland consists of the following components:

• glandular lobules, which consist of adipose and connective tissue;
• nipple - a pigmented, rough formation, the color of which can have different shades;
• areola, which can also be of different shapes;

The mammary gland is covered with smooth skin. Under the skin there is a fat layer. Under the fat layer is the body of the mammary gland, which is covered with a connective capsule.

In turn, the connecting capsule is suspended on the collarbone. The chest is located at the second and third level of the ribs.

The nipple and areola are approximately located at the level of the fifth and sixth ribs. The inframammary fold is located at the level of the seventh and eighth ribs.

The body of the mammary gland is located in a connecting sheath, which is formed from the superficial fascia. The fascia divides into two plates that surround the gland.

Photo: Mammary gland

A large number of connective tissue “Cooper’s ligaments” are directed from the anterior surface of the mammary gland to the deep layers of the skin, which maintain the shape and structure of the mammary gland.

Between the posterior surface of the fascia and the pectoral muscle there is a loose layer of fatty tissue that tightly covers the body of the mammary gland.

When does an early double bubble most often form?

Of course, not after every operation the patient sees in the mirror the unpleasant consequences of the surgeon’s intervention. But there are options for operations in which the risk is higher:

• with subglandular (under the mammary gland) placement of the endoprosthesis using periareolar access;
• in the subpectoral (between the pectoralis major and minor muscles) using periareolar access to remove excess tissue;
• when forming a pocket between the pectoralis major and minor muscles with submammary (along the inframammary fold) access if the patient has thin, delicate skin.

A double bubble is formed when the surgeon was unable to eliminate his own submammary fold. There are two of them:

Such a fold appears either immediately after surgery, or in the first weeks, that is, after the swelling goes down.

What does the double bubble look like after mammoplasty?

As already mentioned, a double bubble means the appearance of a double fold on the chest.

Depending on the deformation of the breast, it may have a different appearance.

But at the same time, there is always an aesthetic aspect, which, in any type of double fold, makes the breasts ugly, deformed and, of course, requiring surgical intervention to correct this complication.

This complication may look like this:

• breasts are superimposed on one another;
• an implant located in the chest can act as an additional roundness;
• the breast may look as if the mammary gland is flowing down the implant, while the nipple and areola are lowered down; experts call this type of complication the “waterfall effect.”

This complication is characterized by deformation of the mammary gland, when a double fold is formed after installation of the implant.

The prosthesis looks like additional roundness. This has the appearance of a bifurcated mammary gland or double bladder. This complication ranges from 30% of all breast augmentation operations performed.

Main complications after mammoplasty

As after any operation, complications are also possible here. Here are the main ones:

• suppuration, infection
• scars
• prosthesis migration
• seroma
• double bubble after mammoplasty (the so-called “double fold”)
• capsular contracture
• numbness of nipples, loss of sensitivity
• ripples on the skin
• bleeding
• implant rupture or crack

An unpleasant side effect (quite rare, but still existing) is a double fold (bubble). It may not occur immediately, but rather late, three to four months after the operation. Double bubble after mammoplasty

does not always arise through the fault of the surgeon: sometimes it is caused by the individual anatomical features of the gland. In fact, an additional circle in the form of a fold or bubble is formed by the implant, which never connected with natural tissues and slid down. Such unsuccessful mammoplasty needs quick and careful correction.

Contracture after surgery

– an extremely common complication of mammoplasty, it occurs in 10% of all patients. This is a capsule-shaped tissue formation around a fresh implant, a kind of protective response of the body to the invasion of a silicone guest. Contracture itself is not dangerous and is not considered a serious complication unless it is large and does not deform the prosthesis, causing it to rupture.

Seroma after mammoplasty

is an accumulation of intercellular fluid in one of the breasts. It becomes noticeable soon after surgery and can be corrected surgically or medicinally. Most often, the serous fluid is pumped out with a syringe, monitoring the result on an ultrasound.

If there is a strong and asymmetrical displacement of one implant, when the defect is clearly noticeable and does not look aesthetically pleasing, repeat mammoplasty

. And to avoid “seasonal migration”, you need to purchase high-quality compression garments and not remove them without the surgeon’s permission.

Increased temperature after mammoplasty

absolutely normal in the first days (while you are in the hospital). This is how the body encounters a foreign body and reacts to swelling. However, if a sudden fever finds you at home, this may indicate that an inflammatory process has begun - rush to the doctor.

Photo: Before and after surgery

How to choose a surgeon for mammoplasty? Reviews and recommendations

Doctors themselves constantly repeat how modern, safe and relatively accessible mammoplasty has become today; reviews after the operation, however, are also negative. Before you gather your courage and sign up for a consultation, you should carefully study all the possible pitfalls and consequences of optional surgical intervention.

Having finally decided that you need mammoplasty, you should read reviews about doctors and clinics in advance. There are plenty of forums on the Internet where people share their own stories, honest assessments, before-and-after photos, and advice.

By typing in a search engine, for example, “ mammoplasty, Moscow, Babayan Gaik Pavlovich

", in one click you will find out all the opinions about the results of the work of the eminent doctor.

If you want to find out why repeated breast augmentation operations are performed (the first one was unsuccessful), how the mistakes of a plastic surgeon are corrected and what they depend on, watch the video.

Thanks to the reviews, you can create a personal rating of plastic surgeons in Moscow for mammoplasty

. And you will choose a specific specialist from several of the best during a personal consultation (based on internal comfort, degree of trust and pricing policy).

Causes

A double bubble can occur for several reasons, and this complication is also associated with the technique of breast surgery.

The main reason for the appearance of a double bubble after plastic surgery is a reduced, underdeveloped lower pole of the mammary glands.

In this case, the main part of the glandular tissue is located in the upper pole of the mammary gland.

At risk are patients with:

• tubular;
• cone-shaped;
• or a normally formed mammary gland;
• but at the same time with exaggerated inframammary folds.

This reason for the appearance refers to the early appearance of a double fold.

The tubular breast shape has an excessively narrow base and large areolas in diameter, and the inframammary fold is too high. With this form, the glandular tissue is concentrated in the upper pole and has a tube structure.

Cone-shaped is a shape in which the breast is three to four times wider than the nipple-areolar complex of the breast, while the shape of the mammary gland has the appearance of a pyramid.

The main reasons associated with the appearance of the late “double bubble” effect are as follows:

• mammary fibrosis;
• gland sliding off the implant or “waterfall” effect;
• lowering the implant below the formed fold.

With mammary fibrosis, the capsule contracts, the prosthesis contracts, and the soft tissue of the mammary gland rises to the top, while the implant itself moves down.

Who is at risk of forming a double bubble?

The doublebubble effect after mammoplasty is most often diagnosed in women who have:

1. Breasts have a tubular appearance (extremely narrowed base of the breast and excessively wide diameter of the areolar-nipple complex). In this case, the inframammary fold is located much higher than normal, and the presence of a significant amount of glandular component in the upper half of the bust is noted.
2. Cone-shaped configuration of the mammary glands, when the area of ​​the breast itself is large, and the area of ​​the nipple and areola, on the contrary, is narrowed (resembles a pyramid).
3. Normal bust shape, but the inframammary folds are much higher.
4. Congenital breast asymmetry. With this defect, there is a possibility of a surgeon’s error in calculating certain parameters necessary for the operation.

The double bubble effect can develop even in women with normal breasts with any plastic surgery with implants. But most often this complication appears in the following groups:

• In women with tubular mammary glands. The peculiarity of the structure of such breasts is a narrow base, a wide areolar area and nipple. Therefore, when installing an implant, the plastic surgeon should choose the optimal access so that the own submammary fold is completely gone and a new one is formed.
• Girls with cone-shaped breasts are pyramid-shaped. At the same time, the nipple and areola area are very narrow compared to the base. If excess skin and fatty tissue are not removed, the implant may “fall” into its own large submammary fold.
• Girls with normally developed mammary glands, but with a high submammary area, should also be wary.
• Organ asymmetry can also contribute to inaccurate surgical calculations. As a result, the likelihood of a double bubble effect will be higher.

What to do

To eliminate this defect, additional surgical intervention is necessary, in which it is necessary to excise the breast tissue, straighten it and form a fold in a new place.

The operation of correcting a double bladder is, on the one hand, very simple, but on the other hand, it requires care and respect for the mammary gland.

What is difficult about this operation is that you need to carefully straighten the breast tissue in order to fix it correctly and form a submammary fold in a new place to obtain an aesthetically beautiful result.

The main goal of the operation is to move the inframammary fold down to the correct position. First, a skin incision is made, the gland tissue is released, isolated from both sides, then the gland is dissected.

After straightening and unfolding the folds of tissue, the gland is sutured to a new submammary fold. As a result, the deformation is eliminated, and the submammary folds become smooth and symmetrical.

Also, when correcting a double fold, the following manipulations can be performed :

1. capsulotomy;
2. removal of the prosthesis;
3. installation of a new prosthesis;
4. breast lipolift.

This complication may be preceded by complications in the form of capsular contracture - the formation of a thick fibrous capsule, which seems to squeeze out the implant and, as a result, a “double bubble” effect is formed.

To do this, the plastic surgeon performs a capsulotomy process, excising the excess fibrous compaction around the implant.

Sometimes the process of removing the implant becomes inevitable. This happens mainly due to the individual characteristics of the patient’s body, for example, a caused allergy to the material from which the prosthesis is made.

As a result of such an allergic reaction, swelling of the breast tissue occurs and with such swelling the implant is compressed and the breast is deformed and it looks like a double bubble.

In this case, it is necessary to immediately remove the implant, since the caused allergy threatens not only the aesthetic appearance, but also the health of the patient.

Also, if low-quality prostheses were chosen when choosing an implant, they also need to be removed, because the breasts will be constantly deformed and the woman will not feel beautiful and confident.

Photo: Breast lipolift

Breast lipolifting is one of the most popular solutions for eliminating double folds and even breast enlargement, without the use of implants.

This operation is performed by transplanting the patient’s own adipose tissue from places where there is a lot of it.

When performing breast correction using lipolifting, fat is injected into the anatomical area of ​​the breast and the specialist who performs this procedure can correct and create an individual breast shape in each case separately.

In order to avoid a double fold, a combined installation of the implant is needed, or in other words, the formation of a two-plane bed for it.

With this process, the upper part of the implant is installed under the pectoralis major muscle, while pressure is exerted on it from top to bottom and with this arrangement the prosthesis is in a straightened state and has a constant shape, which allows the formation of a normal lower pole of the mammary gland.

If the prosthesis is completely under the muscle, including the lower pole, then due to this work of the lower muscles, the implant is squeezed upward and the “double bubble” effect is obtained..

Methods of prevention Speaking about methods of prevention can be divided into three stages.

The first stage includes all the actions that are carried out before the operation itself regarding breast plastic surgery, these include:

1. choosing a plastic surgeon;
2. passing all necessary tests;
3. compliance with all recommendations of the plastic surgeon;
4. choosing a clinic;

Find out what contracture is after mammoplasty.

When are sutures removed after blepharoplasty? Read the article.

The second stage is directly related to the operation itself and there must be correct manipulations by the plastic surgeon himself.

These include:

• correct anesthesia ratio;
• choosing the location of the implant;
• correct application of the necessary cuts;
• suture technique;

The third stage of preventing the “double bubble” complication, in which all responsibility falls on the patient’s shoulders, since this is a rehabilitation period in which the patient must behave responsibly in relation to her health and the aesthetic appearance of her figure.

During the rehabilitation period, the following recommendations should be followed:

• wearing compression garments;
• limiting physical activity;
• compliance with the recommendations of the attending physician;

Causes of early postoperative deformity

There are not many reasons for this phenomenon immediately after surgery:

• incorrect plastic surgery: mistakes made by the plastic surgeon during the implantation process;
• incorrect choice of shape and size of the endoprosthesis;
• violation of the rehabilitation regime by the patient (the most common factor);
• other complications causing deformation.

Medical errors include too ardent tissue removal for mastoptosis. Sometimes the doctor removes a large amount of fat in the area of ​​the inframammary fold. And then a pocket is formed in it, into which the prosthesis is lowered. This is not the norm, but it happens.

Another mistake is the choice of access point or location for installing the prosthesis that is not consistent with the patient’s anatomy. And the last flaw is the defective formation of a pocket for the implant.

When choosing the implant size, it is important to take into account not only the patient’s wishes, but also your anatomy. Bigger is not always better. In addition, the shape of the endoprosthesis is important. For example, in tubular breasts, a low-profile prosthetic anatomist often produces the described defect.

Neglect by a woman to wear compression garments, early resumption of active sexual life and excessive physical activity during the rehabilitation period most often lead to the described deformity.

Fibrous changes in breast tissue caused by surgery lead to displacement of the endoinsert and the formation of a double bubble.

Women with certain anatomical features are at risk for double bubbles:

• tubular breast;
• underdeveloped lower chest (shortened or reduced);
• conical bust;
• pronounced subglandular fold in women with thin skin.

To prevent Double Bubble, plastic surgeons often resort to double cover for the prosthesis or combined formation of a pocket, placing it partly under the gland and partly under the pectoralis major muscle. This arrangement secures the prosthesis as much as possible and prevents it from moving.