Double Bubble Breast Implant Deformity

A double bubble breast implant deformity describes the appearance of two curves or breast creases at the bottom of the breast.
The issue is largely a cosmetic one and may not need to be addressed if it doesn’t bother you. A double bubble can also be corrected.
Correcting a double bubble deformity requires a plastic surgeon to determine and fix the underlying reason for the second breast crease.
Woman covering one breast with her hand against a dark background, illustrating double bubble breast implant deformity

What is a Double Bubble Breast Implant Deformity?

A double bubble deformity is a breast implant issue that causes the breast to appear as if it has two breast creases, or inframammary folds. While a normal breast has one curve at the bottom, a double bubble deformity creates two such curves. Affecting only one or both breasts, this deformity can be caused by breast implant displacement, but that’s not always the case. Some women experience the issue shortly after their breast augmentation while others enjoy their implants for many years and then experience a double bubble later.

What Causes a Double Bubble Breast Deformity?

Patients often assume that a double bubble deformity is the result of a shifted implant, and it is true that implant malposition can cause the issue. But it’s not the only possible source of the problem. A double bubble can occur for several other reasons as well. Your plastic surgeon needs to determine the specific cause of your double bubble implant deformity in order to properly correct it.

Implant Displacement

Implant displacement, specifically an implant bottoming out, can cause double bubble deformity. In this case, the breast implant shifts downward and dips below the original inframammary crease. The old crease remains visible above the implant’s new lower edge, creating a second curve at the bottom of the breast. This can happen because of pocket stretching, tissue weakness, implant weight, or disruption of the breast fold.

A high-riding implant can also cause a double bubble deformity. In this case, the implant is pushed upward or never falls after the initial breast implant augmentation. The bottom of the breast implant may be visible above the intended inframammary crease if the implant sits too high.

Waterfall Deformity

In a waterfall, or Snoopy deformity, the implant may remain in its proper position while the breast tissue around it moves downward or sags. This too can create a double bubble deformity in which the bottom of the natural breast tissue sits below the bottom of the breast implant. Essentially, a waterfall deformity is the opposite of breast implant displacement. This pattern is more likely in patients who had sagging breasts before augmentation and might have benefited from a breast lift.

A Tight or Constricted Original Breast Fold

Some patients naturally have a short nipple-to-fold distance, tight lower breast tissue, asymmetrical breast creases, or a constricted/tuberous breast shape. As a result, there may not be enough tissue to adequately stretch over the newly placed implant. If there isn’t, the bottom of the implant may be visible along with the original breast crease. Surgeons account for this by lowering or releasing the existing breast crease, but sometimes the original crease remains visible.

Capsular Contracture or Implant Position Changes

In some patients, an excess of scar tissue forms around the breast implant. When it does, it places pressure on the implant that alters its shape, position, or both. A displaced implant can shift in a way that causes the appearance of a double bubble.

Natural Causes

A double bubble breast implant deformity isn’t always the result of a problem like scar tissue or implant malposition. Sometimes it’s simply a product of nature taking its course. Aging, pregnancy, breastfeeding, and significant weight changes can all change breast tissue. While these events don’t necessarily end in a double bubble, they can.

How Can You Tell If You Have a Double Bubble?

If you fear you have a double bubble deformity or another breast implant issue, it’s best to be evaluated by a plastic surgeon. But there are some clear signs of a double bubble you can look for. Visual indicators of a double bubble include:

  • Two distinct creases at the bottom of the breast
  • Horizontal indentation or band across the lower breast
  • A second rounded bulge below the natural breast tissue
  • A clearly visible implant bottom separate from the natural breast contour
  • One breast developing a lower fold that does not match the other
  • A second breast crease that becomes more noticeable when:
    • Raising the arms
    • Bending forward
    • Lying down
    • Flexing or changing body position

Double Bubble vs. Normal Implant Settling

A change in your breast implants as you recover from your breast augmentation surgery doesn’t mean you’re headed for a double bubble. New implants often look high, tight, and asymmetrical. Your implants will drop a bit as they settle into place, and the process can take several months. A persistent second crease or indentation after healing is more concerning than temporary early swelling or implant settling.

How is a Double Bubble Breast Implant Corrected?

Plastic surgeons can correct double bubble breast deformities, but the way they do so varies based on the reason for the problem. Fixing a double bubble can involve:

  • Tightening part of the implant pocket (capsulorrhaphy)
  • Reconstructing or repositioning the inframammary fold
  • Releasing restrictive tissue bands or the old breast crease
  • Adjusting the implant pocket
  • Repositioning the implant
  • Exchanging the implant for a smaller one
  • Removing the implants altogether
  • Addressing capsular contracture if present
  • Adding a breast lift to correct sagging
  • Reinforcing the breast pocket with natural tissue or surgical mesh
  • Fat transfer to pad and smooth the visible implant edge

Can Double Bubble Return After Revision?

Unfortunately, a double bubble deformity can come back after a revision. The key to preventing recurrence is to properly assess and correct the reasons for the initial double bubble. It’s vital for implant revision surgery to focus on the mechanical cause of a double bubble rather than just eliminating the visible crease. Because a double bubble could recur, some patients are hesitant to undergo another surgery, and we understand that.

Revision itself carries risks such as capsular contracture, scarring, recurrent malposition, asymmetry, and the possibility that a minor cosmetic issue could become a more complicated surgical problem. If your double bubble is mild and not causing any pain or problems other than cosmetic issues, you can decide to leave it as is. If you do decide to pursue revision surgery, we cannot promise that your double bubble will never return. We can, however, assure you that we will do everything in our power to prevent it and will be honest with you about your potential benefits and risks of revision.

Frequently Asked Questions

No. Irregularities and indentations present as you recover from your breast augmentation will likely resolve themselves as your breast implants settle into position. But a persistent deformity or a double bubble that appears long after your breast augmentation isn’t going to correct itself.

Not necessarily. Replacing heavy or oversized implants during your double bubble correction surgery may be a vital part of ensuring that your deformity doesn’t return, but it likely won’t be enough to solve the problem on its own. Oversized implants may have stretched the pocket or caused breast tissue sagging, both of which need to be corrected as well.

Sometimes a double bubble appears during or shortly after breast augmentation recovery. But some patients develop this deformity years after getting their breast implants. There is no specific timeline, and a double bubble implant deformity can occur at any time.

Although it can be uncomfortable or cause a pulling sensation, a double bubble breast deformity usually isn’t dangerous. You should seek the advice of a doctor, however, if you experience pain, sudden swelling, redness, trauma, or abrupt changes because you could be experiencing a different, more serious complication.

A double bubble breast implant deformity can and often does happen only in one breast. There are natural differences in breast crease height, pocket dimension, and implant position that can make one breast more prone to the deformity than the other.

Although rare, a double bubble deformity can occur with any type of breast implant. The weight and size of an implant can affect the likelihood of a double bubble, but the interplay between breast anatomy, pocket position, the breast crease, and tissue support can all play a significant role.

Yes. Tuberous breasts often have a very tight or high inframammary fold that must be modified during breast augmentation. If your breast tissue does not fully adapt to these changes, a double bubble breast deformity can result. Sometimes the old breast crease is stubborn and remains visible after augmentation.

Some of our patients report that wearing a supportive bra or compression garment eases the discomfort they feel as a result of their double bubble. If they help you feel better, we encourage you to wear them. But these garments cannot correct or resolve a double bubble.

Most plastic surgeons recommend waiting six months to a year before pursuing breast augmentation revision surgery to fix a double bubble. You should be fully recovered from your original breast augmentation procedure, and your breast deformity should be stable and unchanging. The rules might change if another complication is present, however, so a consultation with a plastic surgeon is never a bad idea.

You may or may not need a breast lift to correct your double bubble deformity. If the double bubble was caused by sagging natural breast tissue, a lift is generally a necessary part of correction. But some patients do well with only a pocket adjustment or breast crease correction.

A double bubble deformity can get worse if the breast tissue or pocket continues to stretch, but sometimes the deformity occurs and remains relatively stable. If your deformity is mild and not bothersome, you and your surgeon can continue to monitor it and address the issue only if and when it becomes more problematic.

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