6 months post op. High profile saline implants were used, 380cc on left, 450cc on right side. My breasts are now getting in the way if my arms and they have a huge gap in between. I have to wear both a bra AND a bra like garment that pushes them together. I have waited 6 months to see if the situation improved before talking to my surgeon. My surgeon says that my sternum is too wide to put them any closer. I am concerned about asking her to fix it. Plus, I am concerned that she doesn't know how.
Breasts in Armpits, Large Gap Between? (photo)
Doctor Answers (20)
Promoted Local Answer
High Profile Implants
One of the problems with high profile implants is that they give lots of projection but have a limited base dimension. For this reason I'm not a fan of them. But I think part of the problem may be surgical. The pectoralis muscles can have multiple rows of insertion toward the sternum. It's necessary to release all of the rows until the most medial (closest to the middle of the sternum) is encountered. This can often improve the distance between the breasts. I would recommend changing to moderate profile with 400-425 on the right and 375 on the left.
Large gap and implants in armpits?
Thank you for your question. There are always options for correcting the above problem. In my opinion, the implant pockets need to be revised, probably a dermal matrix needs to be placed to support the new pocket and keep the implants from shifting, and textured implants can be used to help keep the implants from migrating and stay in a good position. The gap can be closed despite a wide sternum and initial widely placed breasts, however, this is more work than a normal breast augmentation. Seek a few opinions from board certified plastic surgeons.
Pablo A. Prichard, MD
Implants in armpits
I would suggest getting a second opinion. The way to fix it may vary depending on what was done in the original surgery. All of the different options discussed by the other surgeons are possible but which is best will depend on a physical exam and a history of what the first surgeon did. Are you above or below the muscle? As a side note, the width of the sternum is not a major factor. The separation that your breasts have originally, is a factor (those two are not the same thing). Best of luck.
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Breasts laterally displaced
If your implants are laterally displaced, then you need to have capsulorrhaphies laterally to bring them more medially( toward the sternum)
Breast augment revision
I think you will need the breast pockets revised. I am not personally a fan of high profile implants because they can contribute to the problem you have in terms of the "gap"; moderate profile would be a better solution. Since people don't walk around with their hands over their heads regularly (unless they are under arrest) a photo with your hands at your sides would be much more helpful in evaluating your condition and making a recommendation.
Breast augmentation revision
Preoperative education is key to any plastic surgery procedure. It doesn't necessarily look like anything is wrong with your result, it simply looks like the result that I would expect given your preoperative breast shape and the size of the implants that were used. The shape of the ribcage and sternum impacts the final position of the implants. If the sternum is prominent and the chest wall angles to the sides, then the implants will follow and result in a more pronounced space between the breasts. Not much can be done about this. Larger implants, particulary high profile saline implants, will result in some stretching of the lower pole of the breast which you have. If you are unhappy with your surgical result you should discuss this with your surgeon. Improvement in your breast shape would likely require removal of the implants, replacement with smaller implants (likely silicone), and a breast lift with an anchor-type incision. Every choice carry consequences and it is important to determine what final shape you are really looking for and make sure you convey that to your surgeon. Good luck.
Wide cleavage can be corrected
The images presented are a bit hard to interpret because the arms are up, however reading the description it appears that the implants may be a bit too small in base diameter.
In addition, implants that are placed under the pec muscle move with the muscle contraction and may be pushed to the side.
This problem can be resolved by replacing the implants with a better suited implant type and correction of the muscle and pocket shape and size.
I would recommend a personal consultation with a surgeon experienced in this kind of revision, discuss your personal expectations and review the surgeons results with this procedures.
Best wishes for a successful revision!
Breast implants above the muscle with poor cleavage
You have HP saline implants that have fallen, i.e. bottomed out and stretched laterally. In addition it looks like your implants are above the muscle. Typically with thin patients as yourself, placing implants above the muscle will cut any supporting ligaments that used to be holding the breast tight to the muscle. So if you tend not to form much scar internally your breast will gradually stretch and elongate. This will only worsen with time. I never place implants above the muscle on thin individual as yourself. First you will see or feel rippling more and second if you don't form some internal scar your breasts will be saggy in a few years. Regarding the spacing of your breasts. Your nipples were not terribly far apart to begin with and so with the proper width implant you should have good cleavage. If I were to revise your breast, I would place your implants under the muscle and chose a wider based silicone implant depending on the size you desire to be. I would plicate and close the lateral and inferior pockets. It is important in individuals who do not form much scar to always wear a good supportive bra during the first year until the internal scar/capsule has become stable.
Implant positioning after breast augmentation is a topic I spend alot of time on in the office before surgery. A patients breast shape before surgery is a good indicator of what it will be after. Breast bone width is just one of the features I discuss. The direction your breasts point can be due to the rib structure too. Good support after surgery is very important and I feel not stressed enough to patients. You are lacking inferior and lateral support and discussing this with your doctor will get you the best result. Thank you for your question.
Correction is possible
Dear Maryanne, corrdection is certainly possible but does take some work. On examining you I would want to check the size of the pocket. If there is room medially when you push the implants together then you would do one or both of these. You would close off the lateral pocket and use say a lower profile implant, like a moderate profile plus or style 15. This should correct the problem, altho if you have weak tissue you may also need something like starttice or alloderm to support the implant.
If the implants don't move medially - towards the sternum but do fall under the armpits you would again need to repair the pocket laterally but also release the pocket medially. Speak to your surgeon and get a second opinion if it makes you feel more comfortable before proceeding. Good luck, Dr. Schuster in Boca Raton
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.