Breast augmentation is a transformative procedure that helps women achieve the figure they’ve always desired. However, two common post-surgery complications—bottoming out and double bubble—can affect the appearance and long-term success of breast implants. Understanding how to prevent these issues is essential for anyone considering breast augmentation or revision surgery.
Fortunately, with careful planning, an experienced surgeon, and innovative techniques like the Internal Bra, many of these complications can be avoided, ensuring that your results are both beautiful and lasting.

What is Bottoming Out?
Bottoming out occurs when the breast implant slips below the natural inframammary fold (the crease where the breast meets the chest). This results in the nipple appearing too high on the breast mound, creating an unnatural, elongated appearance. Bottoming out is often caused by the weakening or stretching of the breast tissue or improper implant placement.

What is Double Bubble?
A double bubble deformity happens when the implant descends below the natural breast fold, creating a visible crease or indentation beneath the breast. This can cause the breast to appear as if it has two distinct curves—one at the top and one at the bottom—hence the term “double bubble.”

Why Do These Complications Occur?
Both bottoming out and double bubble deformities occur due to a combination of factors, including:

• Implant size and weight: Larger implants can put excessive pressure on the breast tissue, leading to sagging or displacement over time.
• Weak or thin breast tissue: Some women have naturally thin or weak breast tissue that may not provide adequate support for the implant, making it more prone to shifting.
• Improper surgical technique: Incorrect placement of the implant, an overly large pocket, or inadequate support structures can increase the risk of complications.
• Gravity and time: Over time, the natural effects of gravity can cause the implant to descend, particularly if the tissue is not strong enough to support the weight of the implant.
• Post-operative activity: Engaging in strenuous activities or not following post-surgical care instructions can cause the implant to shift during the healing process.

Preventing Bottoming Out and Double Bubble

To ensure optimal breast augmentation results and prevent complications like bottoming out and double bubble, it’s important to consider the following strategies:

1. Choose the Right Implant Size

Selecting the right implant size for your body is a critical step in preventing complications. Larger implants place more strain on the skin and tissue, increasing the risk of both bottoming out and double bubble deformities. A skilled surgeon like Dr. Revis will guide you in choosing an implant size that matches your anatomy and aesthetic goals, ensuring a natural, long-lasting result.

2. Consider Implant Placement

The placement of the implant—whether submuscular (beneath the chest muscle) or subglandular (above the muscle, beneath the breast tissue)—plays a significant role in preventing bottoming out and double bubble. Submuscular placement provides more support for the implant, especially in patients with thin breast tissue, as the muscle helps to hold the implant in place and prevent it from slipping.

While submuscular placement is generally preferred for reducing the risk of bottoming out, your surgeon will determine the best option based on your anatomy and desired results.

3. Reinforce with the Internal Bra Technique

The Internal Bra technique, pioneered by Dr. Don R. Revis, JR., MD, FACS, is a game-changer in preventing bottoming out and double bubble deformities. This innovative procedure uses biologic or synthetic mesh to create an internal support system for the implant, providing additional reinforcement to the breast tissue.

The Internal Bra acts like an invisible “scaffold” that holds the implant in its proper position, reducing the strain on the skin and preventing the implant from shifting over time. This technique is especially beneficial for women with thin tissue, larger implants, or those who are undergoing revision surgery.

4. Ensure Proper Surgical Technique

The expertise and experience of your surgeon play a pivotal role in preventing complications. A qualified and skilled surgeon, like Dr. Revis, will use precise surgical techniques to create an implant pocket that perfectly supports the implant and prevents it from moving. A well-constructed pocket with the correct dimensions ensures that the implant remains securely in place, reducing the risk of bottoming out and double bubble.

Additionally, Dr. Revis takes care to position the inframammary fold (breast crease) at the correct level, ensuring that the implant sits naturally and doesn’t slide below the fold.

5. Follow Post-Operative Care Instructions

Proper post-surgical care is essential for ensuring a successful recovery and preventing complications. Following your surgeon’s instructions on activity restrictions, wearing a supportive surgical bra, and avoiding heavy lifting or strenuous exercise in the weeks following surgery can make a significant difference in the stability of the implants.

By giving your body the time it needs to heal and the implants the chance to settle into their proper position, you can reduce the risk of complications like bottoming out or double bubble.

6. Avoid Excessive Stretching of the Breast Tissue

Women with naturally loose skin or a history of weight fluctuations may have a higher risk of experiencing bottoming out or double bubble. During your consultation, your surgeon will assess your skin’s elasticity and recommend measures to maintain the integrity of the tissue. In some cases, a breast lift may be recommended in conjunction with breast augmentation to tighten the tissue and ensure proper implant support.

7. Choose the Right Implant Shape

Implants come in various shapes—round or teardrop (anatomical)—and choosing the right one can impact the risk of complications. Round implants are often preferred because they maintain a uniform shape regardless of how they settle. This makes them less likely to cause a double bubble deformity compared to teardrop-shaped implants, which may rotate or shift, leading to an unnatural appearance.

8. Opt for a Skilled and Experienced Surgeon

Choosing a highly experienced and board-certified plastic surgeon like Dr. Don R. Revis, JR., MD, FACS, is one of the most important steps you can take to prevent complications. Dr. Revis has extensive experience in breast augmentation and implant revision surgery, ensuring that each patient receives personalized care, proper implant placement, and the use of advanced techniques like the Internal Bra.

A qualified surgeon will take into account your unique anatomy, lifestyle, and aesthetic goals to ensure that your surgery is successful and complications are minimized.

When to Consider the Internal Bra Technique
While preventive measures like choosing the right implant size and following post-operative care instructions can go a long way in reducing the risk of complications, some women may benefit from additional support provided by the Internal Bra. This technique is especially recommended for:

• Women with thin breast tissue.
• Patients undergoing revision surgery due to bottoming out or double bubble.
• Individuals opting for larger implants.
• Women who want to minimize the risk of future complications and ensure long-term stability.

Secure Your Results with Expert Care
Preventing complications like bottoming out and double bubble is essential for achieving beautiful, long-lasting breast augmentation results. With expert surgical care, personalized planning, and innovative techniques like the Internal Bra, you can enjoy a smooth, complication-free experience.

Schedule your consultation today with Dr. Don R. Revis, JR., MD, FACS, to learn more about how you can achieve the results you desire while minimizing the risk of post-surgical complications.

Your journey to confidence and beauty starts with the right support.