Breast implants can create long-lasting, natural-looking results, but in some cases implant position issues can develop over time. Two of the most common concerns are double bubble deformity and bottoming out. While they may look similar at first glance, these conditions have different causes and require different surgical solutions. Understanding the difference helps patients know when to seek evaluation and what treatment options are available. At Dr. Paul McCluskey’s practice, revision surgery is customized to restore proper implant placement and refine breast contour.
What Is Double Bubble?
A double bubble occurs when the natural breast crease remains visible across the lower portion of the breast, creating the appearance of a second crease or a “double” lower pole. This can make the implant appear too high while the natural breast tissue hangs below.
Common Causes
• Implant placed too high
• Natural breast fold not released enough during the original surgery
• Significant tightening of the lower pole tissues
• Changes after pregnancy or weight loss
• Capsular contracture pushing the implant upward
Patients may notice a ridge under the breast or a visible indentation where the new and old creases meet.
What Is Bottoming Out?
Bottoming out occurs when the implant drops too low on the chest, causing the nipple to sit unnaturally high on the breast mound. The lower breast becomes overly full, while the upper pole appears empty.
Common Causes
• Weakened breast tissue or skin stretching
• Large or heavy implants chosen for a small frame
• Overdissection of the lower implant pocket
• Aging, pregnancy, or weight changes thinning the tissue
• Gravity pulling the implant beyond the intended pocket
Bottoming out often leads to discomfort, asymmetry, or difficulty finding clothing that fits well.
How to Tell the Difference
While both conditions change breast shape, the key differences are:
• With double bubble, the implant is usually too high
• With bottoming out, the implant is too low
• Double bubble shows a crease; bottoming out shows nipple malposition
• Double bubble often affects the upper and lower poles; bottoming out primarily affects the lower pole
A proper examination is needed to determine the cause because treatment differs significantly.
How Revision Surgery Fixes These Problems
Revision surgery at PSI Atlanta focuses on restoring the implant to the correct position and reinforcing internal support.
Treating Double Bubble
• Lowering or adjusting the implant pocket
• Releasing the old inframammary fold
• Correcting capsular contracture
• Switching to submuscular placement if needed
• Replacing implants with a more suitable size or shape
Treating Bottoming Out
• Tightening and rebuilding the lower implant pocket
• Using internal sutures or support materials to strengthen tissue
• Choosing a lighter or smaller implant when appropriate
• Repositioning the nipple or combining surgery with a lift
Revision aims to restore symmetry, balance, and natural contour while providing stronger long-term support.
When to Schedule a Consultation
You may benefit from an evaluation if you notice:
• Implants that appear too high or too low
• Nipples sitting too high on the breast mound
• A crease or indentation across the lower breast
• Lower pole fullness that looks unnatural
• Pain or discomfort around the implant
• Asymmetry or shape changes over time
Early evaluation helps prevent worsening deformities and allows for easier correction.
Expert Implant Revision at PSI Atlanta
Implant position problems are highly correctable when addressed by an experienced surgeon. At PSI Atlanta, revision techniques are tailored to the patient’s anatomy, implant type, and long-term goals. With meticulous planning and specialized correction strategies, patients can achieve smooth, balanced, and natural-looking results once again.
For more information on procedures and treatments offered by Plastic Surgeon, Dr. Paul McCluskey and the Plastic Surgery Institute of Atlanta, visit:
Serving patients in and around Marietta, Atlanta, Roswell, Sandy Springs, Alpharetta, Buckhead, Morningside/Lenox Park, Virginia-Highland, Candler Park, Midtown, Inman Park, Poncey-Highland, Ormewood Park, Georgia and other surrounding areas.