Double fold (aka double bubble) occurs when you can see an outline of the original breast crease under the breast separate and above the post augmentation breast crease which is formed by the bottom of the implant.
For this to occur the patient needs to have an existing natural crease (very flat patients do not have one), and for an implant to be used such that its 12 to 6 o’clock dimension causes the bottom of the implant to extend below the natural crease. You can see an example of this in the photograph. Some patients are at much greater risk than others and your risk can be assessed at your consultation. This patient only got a double fold on one side but it can happen on both sides. Careful operative planning together with sophisticated surgical techniques can eliminate or very much reduce the risk of double fold. See Patient 11 to see how Dr Fleming does this. Surgeons or clinics who only use round implants are very much restricted in their ability to reduce the risk of double folds in susceptible patients.
Full, round D cup using teardrop (shaped) implants – 370cc, extra high profile, shaped, P-URE foam covered silicone gel implants.
The desire was for D cup, full, round looking breasts. You might think a round implant would be the right choice to achieve this but it was not. We identified two specific risks of a poor outcome for this patient because of the shape of her existing breasts in the context of her desired result – a big gap between the breasts and double folds.
She has a wide chest with a substantial gap between her breasts. Unless an implant that is significantly wider than her own breasts is used, the big gap will remain and will in fact look worse because with larger breasts a gap is more obvious. By definition, a round implant is as wide as it is tall so if we had chosen a round implant wide enough to close the gap and give good cleavage, its lower edge would have been well below this patient’s existing breast crease. Because she has a well-defined crease of her own this may not disappear if the new crease formed by the lower edge of the implant is below it. A very undesirable double fold can result as is shown here in a patient who was not given the best implant for her breast shape.
In this instance, double fold was caused by the wrong choice of implant shape.