Subcutaneous Lower Pole Release as Double Bubble Prevention in Constricted Base Breasts: The “Plus One” Augmentation Technique

Abstract Background Breasts with a broad base, constricted inframammary fold (IMF) and a short distance between the nipple and the IMF are predisposed to form a double bubble (DB) deformity. Most publications have focused on the correction of a DB rather than on its prevention and thorough analysis of the IMF. Objectives Introduction of a third dissection plane in breast augmentation for preventing or correcting DB deformities. Methods This study is a retrospective analysis conducted by a single surgeon, involving 46 patients with a well-defined constricted IMF who underwent breast augmentation with the ‘Plus One’ technique between 2019 and 2021. Women who required mastopexy were excluded. All procedures were analyzed for lower pole curvature using visual and graphical photographic analysis. The lower pole breast contour was plotted as a graph for better comparison of outcomes. Breast-Q surveys were conducted before and 3 months after surgery. Follow-ups were done at 2 weeks, 6 months, and 12 months after surgery. Results The curve of the postoperative lower pole was convex in 96% of the cases. In 4%, the curve tends to straighten out in the lower pole. In one case, the curve became concave at one point indicating a DB deformity, making a DB complication rate of 2%. The mean preoperative satisfaction score was 43±2, and the postoperative satisfaction score was 94±3 on the BREAST-Q scale. Conclusions The “plus one” method showed stable and satisfying results and is easily reproducible with a low complication rate. This can also be used as either a prophylactic or corrective measure.