There are many terms being used to describe various uncommon long term complications after breast augmentation/enlargement.
- Snoppy/waterfall appearence
- Double bubble
Sub-muscular implant breast augmentation in ladies with children who have relatively loose skin and lack of collagen tissue can result in snoopy appearance. In this scenario implants is locked in position under Pectoral major muscle whereas the the loose skin continues to sag with time leading to loose breast tissue at the lower pole with implant sitting higher up. This appearance is also referred to as waterfall appearance.
Or it can also be seen in grade 4 capsular contracture after breast augmentation. Once again the implant sits higher up at the upper pole of the breast whereas lower pole is merely empty breast parenchymal tissue sitting in the lower pole.
There is still some debate about the difference between double bubble and bottoming. In my experience double bobble refers to appearance when implant is placed under the muscle (Dual plane sub-muscular) and in due course the implant is displaced caudally (downwards) disrupting infra mammary crease (IMF) and the implant sits below the level of IMF but IMF is completely disrupted. This condition is most likely result of placing a relatively larger implant under the muscle and the other factor facilitating this condition may be that muscle is not divided high enough leaving most of the muscle fibres intact cable of continuously pushing the implant in caudal (downward) direction. This is a very difficult condition to treat. Surgical option is to do re-augmentation with implant place in front of the muscle and reconstructing IMF.
This complication is result of placing the implant in front of the muscle in ladies with weaker breast parenchymal tissue, which is not strong enough to support the weight of the implant and in time breast tissue starts dropping below the level of IMF but nipple may not change much in position relative to the implant/breast drop. This condition can also be secondary to simultaneous breast augmentation and mastopexy when the implant is in from of the muscle. It is also not an easy complication to correct. A lower pole tightening with de-epithialisation at an appropriate level should correct this deformity.
Breast implant bottoming after sub-glandular breast augmentation