Breast Augmentation: Q&A

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Breasts in Armpits, Large Gap Between? (photo)

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.

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19 Doctor Answers | Asked by Maryanne1 in Colorado

Doctor Answers (19)
Community Comments (0)

Large gap and implants in armpits?

Hi Maryanne, 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... more

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. more

Paul Wigoda, MD

4 reviews

Fort Lauderdale Plastic Surgeon

drwigoda.com

Breasts laterally displaced

If your implants are laterally displaced, then you need to have capsulorrhaphies laterally to bring them more medially( toward the sternum)

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

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... more

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... more

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... more

Benjamin Chu, MD

11 reviews

Honolulu Plastic Surgeon

Implant positioning

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... more

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... more

Implants too Far to the Side

You are asking the right questions. Is your surgeon willing, but more importantly, is your surgeon able to correct this? Before you undergo any more surgery, seek out a second opinion. Make sure the surgeon is experienced in revisional breast surgery and ask to see pictures. There are several possibilities to improving your breasts. Without a careful exam and review of your pre-op pictures and operative notes its hard to specific. However, changing to a... more

Implant Malposition

While the views provided are not ideal for the evaluation of your breast, it appears as though the implants are not in the correct position. It appears that the pocket in which the implant sits needs to be corrected by reducing the inferolateral (below and outside) portion of the pocket while most likely having to further release the inferomedial (below and inside) insertion of the Pectoralis Major muscle as well. I would recommend that you get a second opinion from a Board Certified... more

High profile implants are smaller in diameter.

High profile implants have a smaller diameter at the base. A moderte or moderate plus implant may help as well as changing the pocket.

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Correction of Breast Implant Positioning?

Thank you for the question and pictures. Although precise evaluation is not possible based on the photograph (with your arms raised) I think that you are dealing with a breast implant displacement problem. It is likely that your breast implants are displacing too far inferiorly and laterally. Generally, the lateral and inferior (bottoming out) breast implant displacement can be corrected using an internal suture technique, decreasing the size of the breast implant "pockets" and... more

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... more

Large Gap and Implants Under Arms

I would ask the plastic surgeon to help with your concerns. With your arms above your head, it is difficult to properly evaluate the results. If you would like a second opinion, I perform alot of breast augmentation revisions. Kenneth Hughes, MD Los Angeles

Breast Gap Following Breast Augmentation

Hi Maryanne, Thanks for providing pictures of your breast augmentation. I am sorry you are dissatisfied with your augmentation results. From what I can see, your implants are being displaced by the pectoralis muscle, and this can be corrected with surgery. Typically, this requires removing the implants, releasing the muscle close to the sternum, and in your situation, I would consider a slightly smaller implant with a wider base diameter (more of a moderate profile rather than... more

Breast Augmentation Revision

You sound very frustrated and concerned with your results - I agree with your assessment that your implants are far apart. From your pre-op pictures, it looks like you naturally have a wide space between your breasts so that would make me think that you would have one after your augmentation also. Your post-op picture is a little shadowed but from what I can tell, your implants are malpositioned to low also. This is called "bottoming out". I think your problems could... more

Widely-spaced implants

An implant is designed to add volume to the breasts, nothing more. It is not designed to change the basic shape of the breast. Looking at your before and after pictures, it appears that you had a fairly wide cleavage before your surgery that did not change afterwards. This is because you have a very wide chest bone. If you feel over that chest bone you will feel skin and bone. I have seen patients who have come through my door where a doctor has tried to give... more

Breast implants

You want your implants centered behind your nipples. In your pre-op photo there is a wide gap between your breasts, and that should not change with surgery. If you move the implants closer together, there will not be normal breast tissue covering the inside of the implants, and you may see rippling. In addition, it make your nipples point to the side.