Management of a Common Breast Augmentation Complication: Effective Treatment of the Double-Bubble Deformity with Fat Grafting

The double-bubble deformity is one of the most common problems in breast augmentation, with or without mastopexy.  Classically, open techniques have been used to treat this deformity, including elevation and reconstruction of the inframammary crease or parenchymal scoring.   In this study, the author reports experience with a simple, closed technique of serial fat grafting procedures to treat the double-bubble deformity.  Twenty-eight patients with double-bubble deformities were retrospectively evaluated.  Fifteen patients had undergone primary augmentation, while thirteen patients had undergone augmentation mastopexy.   Eight patients presented with bilaterial double-bubble deformity.   Up to three sessions of fat grafting were performed on each patient, with a mean of 2.1 sessions required for patients in the series.   An average of 27cc of fat was injected with each treatment per breast.  Fat was injected with a 1.5mm blunt cannula into the subdermal and superficial breast tissue layers beneath the old inframammary fold.  There were no oil cysts, infections, or donor site problems noted in the series.  Twelve patients with limited breast tissue underwent MRI examination at the conclusion of the fat grafting sessions, and no implant injury or disruption was noted.  All patients were pleased with the results of treatment and no revisional surgery was required.  This study suggests that fat grafting is an effective treatment of the breast double-bubble deformity.   The procedure allows the correction of a challenging deformity with a simple, closed technique which is safe and cost effective.