Breast augmentation is the ‘simple’ procedure of placing an implant to increase the size of the breast. It does so by pushing out the overlying soft tissue and creating a bigger mound. While the increase in breast size is always completely predictable, the final shape that the breast will achieve is not.
The breast may not necessarily mimic the shape of the implant that is pushing it outward. One’s breast has its own natural shape controlled by the amount of skin and the thickness of the underlying breast tissue. Thus when pushed outward any irregularities and asymmetries in the breast will ultimately be seen.
This is particularly true in such deformities as the tuberous breast or the breast with the very short nipple to fold distance. When an implant is placed in this type of breast shape, the lower pole of the breast is tight and the original inframammary fold remains, creating a crease across the enlarged lower pole. This creates what is known as a ‘double bubble’ deformity.
The double bubble deformity is a well recognized problem in certain breast augmentation patients. When recognized during surgery, and it often is, release of the lower quadrant of the breast is done by making releasing cuts or sections in the breast tissue. With this manuever the double bubble will improve immediately or will relieve itself in the early postoperative period. This is most easily done when a lower breast fold or an inferior areolar incision is used. It can also be done, although less effectively so, through a transaxillary incisional approach by an endoscopic technique.
Another treatment option for the double bubble breast augmentation deformity that fails to improve with the aforementioned techniques is fat grafting. Fat grafting helps correct the double bubble by providing additional tissue to the lower breast pole and adds a remodeling effect. By injecting autogenous fat into the constricted and tight lower pole, some degree of immediate soft tissue expansion occurs.The additional cellular material (fat and stem cells) also provides a matrix for tissue regeneration to aid the postoperative stretching of the tissues so that scar is not the only tissue formed.
Fat injections for the breast double bubble breast deformity can be done either at the time of implant placement or for the refractory double bubble problem secondarily. That is a judgment that is made during surgery. The fat injections are done by placemen just under the skin by a small cannula technique.
Dr. Barry Eppley
Indianapolis, Indiana