Double Bubble Deformity
The patient below presents with severe double-bubble deformity. The implant is superiorly retropositioned with severe malposition. She also has enlargement of the right areola. There is severe scar tissue with a Baker IV capsular contracture. The patient will undergo bilateral open periprosthetic capsulectomy, release of the infraclavicular capsule and release of the parasternal attachments of the pectoralis major muscle. The most significant deformity of the breast bilaterally is the inadequate release of the pectoralis major muscle along the parasternal ridge as well as along the lateral inframammary fold creating what I refer to as a “catcher’s mitt” phenomenon and leading to superior elevation of the implant in an unnatural appearance.
The patient is now postoperative day 1 after circumferential open capsulotomy, complete open capsulectomy, complete resection of the medial attachments of the pectoralis major muscle and reconstruction with a style 45, 500 cc Natrelle gel implant. The patient now has perfect symmetry, elevation has been corrected, the inframammary folds are even and a right areolar reduction has been performed to recreate a symmetric size to the nipple areolar complex.