Monday, March 15, 2010

Double-Bubble Breast Deformity

Recently a Staten Island woman was awarded $3.5 million after developing a double-bubble breast deformity after a breast augmentation/mastopexy surgery.

I don’t know if the award was warranted, but I do know that the deformity is a known risk of breast augmentation surgery. I try very hard to tell patients about possible risks of surgery, but none of us go into surgery thinking we will be the half or one or two percent.

As the surgeon, I take pride in my work and give the best I can. It is never my intention for a patient to have a poor result. It is not good for them or for me.

So let’s talk a minute about double-bubble deformities. What is it? In a double bubble deformity the implants are usually positioned too superiorly under the muscle (first bubble) with an overhang of skin/breast tissue drooping lower (second bubble). (photo credit)

Patients with significant postpartum atrophy, glandular ptosis, and significant native tissue volume are at a higher risk for developing a double-bubble deformity.

In patients with the above, it is best to consider placing the implant in the subglandular position rather than the submuscular. It is also important to consider doing the mastopexy first and the implantation procedure at a different surgery in the future.

Another important consideration is doing the proper lift procedure so that enough skin is removed. This may mean the patient has to accept more scars (ie an anchor scar rather than inferior vertical scar, or an inferior vertical scar rather than a periareolar scar).

Once the deformity has developed, then correction may require capsule work, repositioning the implant, revising the mastopexy (or adding one).

REFERENCES

Breast Augmentation; Plastic and Reconstructive Surgery. 114(5):73e-81e, October 2004; Spear, Scott L.; Bulan, Erwin J.; Venturi, Mark L.

Breast Augmentation: Choosing the Optimal Incision, Implant, and Pocket Plane; Plastic and Reconstructive Surgery. 105(6):2202-2216, May 2000; Hidalgo, David A.

Shaping the Breast in Aesthetic and Reconstructive Breast Surgery: An Easy Three-Step Principle. Part IV-Aesthetic Breast Surgery; Plastic and Reconstructive Surgery. 124(2):372-382, August 2009; Blondeel, Phillip N.; Hijjawi, John; Depypere, Herman; Roche, Nathalie; Van Landuyt, Koenraad

Breast Asymmetry; Aesthetic Surgery Journal, Nov 2003 (Vol. 23, Issue 6, Pages 472-479); Daniel C Morello, Marie Christensen, David A Hidalgo, Scott L Spear

Treatment of Breast Ptosis; Aesthetic Surgery Journal, July 2003 (Vol. 23, Issue 4, Pages 279-285); Stephen R Colen, Sharon Y Giese, Ruth Graf, Dennis C Hammond

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