Breast augmentation is one of the most popular cosmetic procedures, but like any surgery, complications can occur. Two of the most misunderstood postoperative issues are double bubble and capsular contracture. Although they may look similar to patients, they stem from entirely different causes and require different treatment approaches. Board-certified plastic surgeon Dr. Bryson Richards provides breast revision to patients in Las Vegas, NV, and surrounding locations.
What Is a Double Bubble?
A double bubble deformity occurs when the implant and the natural breast tissue do not align smoothly, creating the appearance of two breast folds. This can give the breast a “double” crease or a distinct step-off between the implant and the lower breast pole.
Common causes include:
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A high implant that does not fully settle
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Overly tight or strong natural breast crease (inframammary fold)
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Implant placed too low
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Bottoming-out over time
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Anatomical mismatch between the implant size and the patient’s natural tissue
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Capsular contracture pulling the implant upward (secondary double bubble)
Some cases appear early after surgery, while others develop months or years later due to natural aging or changes in breast tissue.
What Is Capsular Contracture?
Capsular contracture occurs when the scar tissue (capsule) that naturally forms around the implant tightens excessively. This contraction can squeeze the implant, distorting its shape or position.
Symptoms may include:
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Hardening of the breast
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Distorted or round, ball-like appearance
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Pain or discomfort
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Rising of the implant on the chest
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Firmness and visible asymmetry
Capsular contracture is graded using the Baker scale, from mild firmness (Grade I–II) to painful, visible distortion (Grade III–IV).
Key Differences Between Double Bubble and Capsular Contracture
Although both affect breast appearance, they originate from different issues:
| Feature | Double Bubble | Capsular Contracture |
|---|---|---|
| Main Cause | Misalignment of implant + natural breast fold | Tightening of internal scar tissue |
| Appearance | Two lower breast creases (“double” fold) | Hard, round, overly high implant |
| Pain | Usually none | Possible discomfort or pain |
| Treatment | Implant repositioning or fold adjustment | Capsulectomy or implant replacement |
Understanding these differences is essential for determining the correct revision approach.
How Dr. Richards Diagnoses the Issue
A thorough evaluation includes:
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Physical exam of breast shape and position
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Assessment of implant type and placement
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Review of surgical history
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Ultrasound or imaging in complex cases
Correct diagnosis is crucial, as treating one condition with the wrong technique can worsen the outcome.
When Revision Surgery Is Recommended
Both conditions can be corrected surgically, but the techniques differ significantly. Dr. Richards designs a personalized revision plan based on the underlying cause, breast anatomy, and long-term goals.
If you suspect changes in your breast shape or firmness, schedule an evaluation at Richards Cosmetic Surgery. Expert diagnosis ensures you get the right treatment, the first time.
Contact Las Vegas Board Certified Plastic Surgeon Dr. Richards to Schedule a Consultation
If you would like more information on cosmetic surgery procedures and treatments performed by Las Vegas, Nevada plastic surgeon, Dr. Bryson Richards please contact us at 702.870.7070
Taking new patients from Las Vegas, Bullhead City, Laughlin, Pahrump, Mesquite NV and surrounding areas.
A double bubble deformity can be distressing for breast augmentation patients, especially when it affects symmetry or confidence. The good news is that double bubble is highly correctable with the right revision approach.