The double-bubble deformity: cause, prevention, and treatment.

[BACKGROUND] The double-bubble deformity is a widely recognized complication of breast augmentation, but there have been very few articles in the peer-reviewed literature devoted exclusively to this topic.

[METHODS] Prior publications addressing the anatomy of the inframammary fold and its relationship to the double-bubble deformity are systematically reviewed. Disagreements among authorities regarding the precise anatomical structure of the inframammary fold are addressed. The cause and surgical correction of the double-bubble deformity are discussed in detail as they relate to the anatomy of the fold.

[RESULTS] The key to understanding the causes and correction of the double bubble lies in an appreciation of the anatomy of the inframammary fold. Correction of the deformity varies depending on whether or not patients had preexisting anatomical features predisposing them to development of a double bubble.

[CONCLUSION] A variety of surgical strategies, including use of a dual-plane pocket, form-stable shaped implants, capsulorrhaphy, pocket plane conversion, and use of acellular dermal matrices can play a role in prevention and treatment of the double-bubble deformity.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, V.