How Do I Avoid Getting a "Refund Gap"?

I am scheduled for a breast augmentation on the 20th of this month with Dr.Guerra in Scottsdale,Az. Iv been wanting am augmentation for years but my biggest concern is ending up with a "refund gap" you know, the abnormal amount of space between breasts. What causes this?! How can i explain my concern to my doctor? Im 5"2 and 110 lbs, currently a 32B, looking to go to a 32DD. Thank you.

Doctor Answers (17)

Increasing cleavage


The abnormal wide space between the two breasts can be reduced transposing the breast tissue medially.  This can be done through a circumareola approach.  There is a new technique called The Mini Ultimate Breast Lift and can be used simultaneously with a breast augmentation.  When placing implants retro-pectoral, it may be difficult to go from a 32 B to a 32 DD.

Best Wishes,

Gary Horndeski, M.D.

Texas Plastic Surgeon
5.0 out of 5 stars 123 reviews

Gap Between Breasts?#breastimplants


Miladoll, thanks for the question. I feel that good communication with your surgeon is always very important. I tell my patients that most of your cleavage is determined by your anatomy. The pectoralis muscle attaches to the breast bones on either side at defined positions. This will largely set the tone for what kind of cleavage you will or can have. The other aspects are the profile of the implant and the dissection of the pocket. Communication is key with your surgeon and spending the time to really communicate is so very important. If you trust in your surgeon and feel that you have really together defined your goals you should have a great result. Aldo is a great guy,a great surgeon and he will treat you well.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 14 reviews

A Refund Gap?


Your question has been more than adequately answered by the experts here.  The question you will have to answer for all of us is "Where did you hear of the term Refund Gap?"

David Finkle, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 45 reviews

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A wide breast bone causes a wide gap between the breasts


Thank you for your question. The main determining factor for having a wide separation between the breasts is a wide breast bone. Trying to narrow that distance by putting the implants closer together makes the breasts look abnormal and increases the risk of rippling in that area. 

James McMahan, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 11 reviews

You body shape will dictate the gap


You have chosen a great surgeon and he can answer your questions after examinations. The gap depends on the anatomy and implant position. 

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
5.0 out of 5 stars 54 reviews

Avoidance of "Refund Gap" Post Augmentation


The term "Refund Gap" is not one that I have heard before, but you indicate that it refers to abnormally wide space between the breasts. Everyones breast/chest anatomy is different, and some individuals have a wide space between their breasts before augmentation. While breast implants do improve cleavage, their are limitations (based on your anatomy) to how far the cleavage can be enhanced. If, in an attempt to create more cleavage, a surgeon uses an overly large or wide implant, or overdissects the implant pocket towards the sternum, then the patient can end up with synmastia - a difficult problem to correct.

Another concern is that patients with naturally wide spaced breasts, the nipple can be located or directed more outwards. If an implant is then placed more towards the inside of the breast (in an effort to create more cleavage), then the nipple will rotate even further out and look quite abnormal. It is important to have the implant centered behind the nipple position.

The bottom line is that your own anatomy dictates to a large extent what the final result will look like, and implants cannot change things such as nipple position, or the location of your breast on your chest wall.

Braden Stridde, MD
Federal Way Plastic Surgeon
5.0 out of 5 stars 20 reviews

The refund gap

We're all lifetime learners and now we've learned something new---I had never heard of this phrase and thought it referred to a cancellation penalty. The gap is based on your own anatomy and the distance between the breasts. Implant selection can be a factor and going from a B to DD, if you do have a gap to begin with, will highlight the gap even more. Discuss the sizing and your concerns with your plastic surgeon in person.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

How Do I Avoid Getting a "Refund Gap"?


I have never heard that expression before! It describes the wide space between the breasts. When you see this in post-op photos, the commonest cause is pre-op anatomy. When patients breasts are far apart before surgery, they will be far apart after surgery. The implants are centered according to breast location. If they are placed more centrally than is the breast, the nipple and areola will be on the side of the breast, a finding that is quite bizarre looking, and certainly less attractive than more widely spaced breasts which are a natural variant. 

Choice of implant size and profile can allow for more central fill, with some limitations. Women with widely spaced breasts may consider implants placed above the muscle in some settings, as the sub pectoral position limits the amount of central fill. Placing the implants too close, especially for large implants, can cause symmastia, where there is no separation between the breasts. This is most unattractive, and difficult to treat. 

Thanks for you question and best wishes. Be sure to discuss your concerns with your surgeon.


Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 30 reviews

Gap between your breasts


Though the prvious posts present very detailed explanations, the simplest way to look at this issue is by looking at the width of your chest, the distance between your nipples, and the shape and size of the implant you choose.  You have to center the implant under your nipples.  If your nipples are widely spaced apart, you will have a gap between your breasts unless you use a wide or large implant.  However, this can also create too much breast on the side of your chest (side boob).  You anatomy will determine what options are available.  A photo would help answer your question.

Leonard T. Yu, MD
Kahului Plastic Surgeon
4.5 out of 5 stars 15 reviews

Tell your surgeon you want as narrow cleavage as is safe and anatomically possible!


"Refund gap" is a new one for me, but refers to excessively-wide cleavage. At your petite size and with your large-breast goal, your surgeon should have minimal difficulty helping you achieve your narrow cleavage look--with some anatomic limitations.

If your surgeon creates pockets that are excessively "close" in the mid line in an effort to achieve that "narrow cleavage" you seek, you could end up with symmastia (uni-boob), which is more common with large implants already. This requires expert surgical technique and care by Dr. Guerra.

Be careful during healing to not wear an overly-compressive bra (when your surgeon says it's OK), but one that supports without pressing your implants inward too hard; this can weaken or stretch the attaching fibers that keep your implant pockets separate and your cleavage attached to your breastbone. Good luck and best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 116 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.