Breast Implant Complications: Double Bubble vs Bottoming Out

There are two (thankfully rare) breast augmentation complications that kind of look the same... they’re called ‘Double Bubble’ and ‘Bottoming Out’.

Breast Implant Complications

Although they might look similar they’re actually two totally different things. Let me explain...

Double Bubble Breast Implant Complication

Underneath your breast you have a natural fold, or crease, called the Inframammary Fold (or IMF). It’s part of your breast anatomy.

Double Bubble occurs when a breast implant that’s been placed behind the chest muscle (called ‘unders’) settles below the IMF – in one or both breasts. The result is your IMF crease seems to move up onto the lower part of your breast.

It looks like... 

Breast Implant Complications

...a dent in the lower part of your breast and then what looks like another crease. The double bit is your old crease and a new crease caused and the bubble is a bulge inbetween them.

You see a double bubble most obviously from the side.

Double Bubble can happen if:

  • A surgeon needs to lower your natural breast crease (for example, if there’s a short distance between your nipple and your IMF or if you want big breast implants) and there’s a surgical error meaning the implant settles too low.

  • A breast implant is too big or placed too high the natural breast tissue sags below the implant.

  • You have tuberous breasts, asymmetry or sagging breasts. Placing breast implants often requires moving the IMF surgically, which presents a risk for double bubble occurring.

  • Natural changes to your breasts over time cause sagging of the breast tissue below the implant.

Fixing Double Bubble Breast Implant Complication

Thankfully a Double Bubble complication is rare. The best option is prevention! Which is why it’s soooo important to pick a Board Certified Plastic Surgeon who has extensive experience in breast augmentation.

If a Double Bubble occurs soon after surgery you’ll be advised to wait for up to six months to see if the Double Bubble goes away by itself. If not, or if the Double Bubble occurs longer after surgery (due to breast changes – e.g. natural sagging), a revision surgery is the only way to fix it.

Breast Implant Complications

Depending on the cause of the Double Bubble revision surgery might involve:

  1. Switching breast implants that are under the muscle to over the muscle. By doing this, the attachments between the muscle and the skin are divided and the ‘dent’ on the breast caused by the double bubble complication should fade.

  2. Raising the inframammary fold using internal sutures and if the skin and/or tissues are very thin a special surgical material (called an 'acellular dermal matrix') can be used to reinforce the area. This is a better option if you don't have much natural breast tissue.

  3. Exchanging your breast implants for a smaller size. If the cause of your double bubble is breast implant weight/size you may have to consider a smaller breast implant (and some internal stitching) if you want a long-lasting correction.

  4. Have a breast lift if the cause of your double bubble is pstosis (sagging).

Bottoming Out Breast Implant Complication

Another funny-sounding (although, not funny at all) post-surgical complication is Bottoming Out.

The clue for what this one is is in the name.

Bottoming Out is a breast implant displacement problem that happens when the breast implant drops too low into the breast.

Breast Implant Complications

You kinda have to go back to early breast augmentation recovery to understand the Bottoming Out complication...

After a breast augmentation, breast implants 'ride high' on your chest and they take their time (through a process called 'drop and fluff') to settle down into a natural position in the breast pocket.

If there is not enough support the breast implant can continue to travel south and if it drops too far that's bottoming out.

Support for your newly-placed breast implant comes mainly from your breast skin. If that support isn’t great (i.e. your breast skin is a bit thin or weak) the breast implant will sink towards the lower part of your breast.

You’re at risk of Bottoming Out if you pick a breast implant that’s too big for your body (it’s too heavy to be supported so slips down) or if the breast pocket your breast implant is in is over-dissected (cut too big – which is a surgical error).

The tell-tale signs of Bottoming Out are:

  • From the front your nipple looks too high on the breast and the lower part of your breast looks over-full (with the slipped breast implant) and the top part empty.

  • From the side your nipple will point skyward because the slipped breast implant increases the distance between the bottom of your nipple and your underboob breast crease.

  • Your scars (if you got a crease/underboob/inframmammary incision) may travel up from the crease to the lower pole of your breast.

And it looks like...

Breast Implant Complications

Fixing Bottoming Out Breast Implant Complication

Again, the best way to handle Bottoming Out is prevention!

Choosing the right surgeon is paramount to getting a ‘right first time’ breast augmentation.

You totally need to have a frank discussion with your carefully-selected Board Certified Surgeon about your existing breast tissue and skin during your consultation.

Your existing anatomy will determine the type/size/placement of breast implant that is best for you.

If you have lost skin elasticity (e.g. due to weight loss and breastfeeding) it’s especially important to keep your breast implant size aspirations realistic. Bigger is not better if you want to avoid Bottoming Out.

Overall, listen to your surgeon’s recommendations.

Thankfully Bottoming Out is not very common. If it does occur the only fix is a surgical revision.  It can be a complicated revision process as it isn’t always fixed in one surgery.

Bottoming Out can be fixed in one surgery by removing the old breast implants, placing new smaller breast implants and adding some stitches and/or a special surgical material (called an 'acellular dermal matrix') to give the lower part of the breast extra strength to support the weight of the breast implants.

In some cases breast implants have been removed and the body left to heal (without breast implants) before breast implants can be replaced, meaning more than one revision surgery.


Both the Double Bubble and Bottoming Out breast augmentation complications should be rare with good technique and an experienced surgeon.

If you have any questions or concerns following your breast augmentation procedure reach out to your Board Certified Plastic Surgeon.