A woman from Staten Island, N.Y., is suing her former cosmetic surgeon because, she claims, a botched breast implant surgery left her with "four breasts."
The woman, Maria Alaimo, was 40 years old when she paid about $7,000 for breast implants in 2003. She now alleges that her surgeon, Dr. Ken Keith Berman, was at fault when she ended up with four round bumps instead of two symmetrical C cups, according to court reporting by the Staten Island Advance.
"Maria came out of that operation with essentially four breasts," the Staten Island Advance reports her attorney, Michael J. Kuharski, told jurors during the March 1 opening arguments. Berman's attorney, Jerry Giardina, declined to comment to ABC News. Kuharski declined to elaborate on what he meant by "four breasts" but said he expects the trial to end next week
Yet cosmetic surgeons say they are familiar with what doctors call "double bubble."
"It does not look like four breasts -- you see a fullness on the top, and a fullness on the bottom," said Dr. Michael Olding, chief of the division of plastic surgery at the George Washington University Medical Center in Washington, D.C.
Cosmetic surgeons say the "double bubble" is a real risk of breast augmentation surgery -- even if the average client hasn't heard about it. Occasionally, through negligence or just bad luck, the implants appear as a second bump under the natural breasts.
"The perception is breast augmentation is pretty straightforward -- you put an implant under your breast and it gets bigger," said Dr. Jeffrey Kenkel, a spokesman for the American Society for Aesthetic Plastic Surgery.
In reality, Kenkel said, doctors have to be careful about correct positioning and sizing. Kenkel made an analogy of the breast to a cone: the implant must fit only at the base of the cone and cannot be too narrow or too wide.
"We have to make sure that the implant sits in the best place in the base of the breast," he said. "You have to make sure that the breast sits on the right position on top of the implant."
If the implant is too wide, a patient might get a double bubble right after surgery. But if the implant is too heavy, a double bubble can develop over time as the heavy implant sinks below the crease where the natural breast meets the chest.
Doctors say patient may be at more risk for a double bubble depending on the shape of their breasts.
"Some women have what we call a constricted breast -- the base maybe too narrow, or the distance from the nipple and the crease is very short," said Kenkel, who is also a professor and vice chairman of plastic surgery at the University of Texas Southwestern in Dallas.
"Those (surgeries) are going to be very hard to align at the base of the breast," said Kenkel, who mentioned some techniques that may help doctors loosen constricted breast tissue.
A woman's age and how many children she has had may also put her at risk for the problem, according to Olding.
"After a few deliveries, and as you mature, your breasts sag," said Olding, who added it is not uncommon for women to seek breast implants after they've become unhappy with their breasts later in life.
But surgery becomes more complicated if breast tissue has sagged below the inframammary fold, where the lower part of the breast meets the chest, Olding said.
"If the tissue is below the fold, really what they want is an implant and a lift," said Olding. However, a lift typically leaves a visible scar around the nipple -- something Olding said many patients want to avoid.
According to reporting by the Staten Island Advance, Berman's office did recommend a lift along with breast augmentation.
Olding and Kenkel agreed that careful placement and proper screening can reduce the risk.
"But sometimes no matter what we do, it can happen," said Kenkel.