I have a wide sternum bone could anything could of been done differently to correct that just A LITTLE TINY BIT MORE? (photo)

Question

5 ft 1 half in 105 llbs. Double aa cup preop wanted them bigger but doc said it's a little slower process with me since I had very little skin to work with. Was told about space existing post op didn't think it would be that big. I have a great deal of side booby as well. I'm sad that I wish they were bigger but do u see a revision needed in my future? 375 cc in right and 400 cc in left if I go bigger would they be farther apart and MORE side boob? I'm soon confused and sad.

Kirk Moore, MD · Answer

Preop pics would be very beneficialPictures taken by someone else without your shirt off and with your arms at your side will also help tell whether there is some lateral displacement due to some contraction of your chest holding the cameraAre your breasts hard to the touch--do the implants move around nicely--soft to the touch?Significant medial dissection (over the sternum/breast bone) is fraught with problems and has the potential to create a much more difficult problem to correct, so better done with care, careful dissection. Lower profile implants might make the 'peaks' and 'valleys' look less prominent, if that is an option, based on your breast dimensions.I would recommend discussing with your surgeon and talking thru the options.Best.

Sheila S. Nazarian, MD · Answer

I think your question is whether or not revision surgery would bring your breasts closer together and give you more cleavage? Remember that the implant has to be centered behind your nipple so you are limited by your anatomy. Which doesn't mean that revision surgery couldn't improve your results. Schedule an appointment to speak with your surgeon to discuss your options and then you can decide whether or not it is worth it to you. Best, Dr. Nazarian

Charles Galanis, MD · Answer

Thanks for the post.  We are somewhat limited here without pictures of your preoperative anatomy.  As you  correctly stated, you do have a long intermammary distance or gap between your breasts.  In creating the pocket for the implant, it might be possible to elevate tissue medially to place the implants closer together.  This would run the risk however of distorting your anatomy by (a) displacing your nipples laterally (in other words, they would not be as centered on the implant as they should be and look like they were pointing more to the sides) and (b) increasing your risk of symmastia (where the two breasts essentially become one joined at the middle).Discussing your concerns with your plastic surgeon is a starting point.  You can have a discussion about revision options moving forward.   Good luck!

Thomas S. Taylor, FACS · Answer

You have two issues: a wide sternum and nipples that are very lateral.  It is important to keep the implant more or less centered under your nipple or it will cause your nipple to point even more to the side which won't look good.  Therefore, simply moving your existing implant more centrally and suturing down the lateral pocket won't make you happy.  Your cleavage will look closer and better but trust me your nipple position will bother you a lot!  However, if you pick a larger and wider implant I am confident the cleavage can be moved in with some basic, safe muscle dissection and your nipple position will remain the same.  That procedure is fairly straightforward.  I hope this information helps!Thomas Taylor, MD, FACSPasadena, CA

Shim Ching, MD · Answer

Your breasts are widely spaced.  If you want your breasts slightly close together, fat grafting to the medial poles of the breasts could help.  If your implants are revised to larger, wider implants, you may have more fullness on the outside of your breasts.  It could be that limited medial (inner part of the breast) dissection was done.  In a revision, the surgeon could determine in surgery if this could help you or not.

Manish H. Shah, MD, FACS · Answer

Hello Suikiu,Thanks for your question.It is possible to dissect a little more medially to open the pockets centrally and decrease the side boob.However, if you surgeon is aggressive he/she may create a problem where the two breast implant pockets meet called symmastia.It is possible to add material known as Acellular Dermal Matrix (ADM), tissue derived from human and pig sources that can allow your surgeon to be a bit more aggressive and create tissue barriers that open the central pocket even more without allow for symmastia.Ultimately the change will be mild-moderate depending on the skill of your surgeon and the anatomy.Going bigger may not be the answer as this will increase side boob if you can't push the implants closer to each other.It is important to let the skin have time to stretch and soften before you try any further surgery.Good luck,Dr. Shah

Curtis Wong, MD · Answer

but revisions are needed.  When faced with your situation, my patients are asked to pick the size implant they want.  I choose the style and often, it will be the widest ones to help diminish the space between the mounds.  But they are also told that they will have space still... but they should be able to push their breasts together with a bra.  With moving your implants more medially, your nipples will rotate lateral and are you okay with that look?  You can be better but it will cost more and could involve larger implants.

Claire S. Duggal, MD · Answer

Thank you for your question and your pictures.  You are right in your understanding that a wide space recognized pre-operatively translates into a wide space post-operatively, and sometimes it is emphasized when your breasts are bigger.  It is important to keep implants centered under your nipple otherwise your nipples will look as though they are pointing more to the sides.  One option for camouflaging that space a bit would be fat grafting to the medial aspect of your breast and your sternum.  That would decrease the stepoff between your implants and your sternum and help to fill that area a bit.  Best of luck with your process!

Ed Breazeale, Jr., MD · Answer

Thank you for your question. Your sternal gap is a fixed distance and should not be violated. You could possibly reduce a bit of the implant width by going with an Ultra High Profile which would be more narrow and more projected. I would schedule an appointment with your Plastic Surgeon and discuss your options. Best of luck to you.

Ciro Adamo, PhD, MD · Answer

I personally don't think your cleavage could be changed significantly. Yes, it is possible to dissect the pockets a bit more medially (toward the middle), but then you are left with the following two options:Move the implants medially too, which would decrease the lateral fullness and make the nipples point outward (to avoid displacement of the nipples, implants must be centered on them)Put wider, possibly larger implants that would come closer to the midline. In this case, a wider implant centered on the nipple would add to the side of your breasts the same amount of fullness that you gain toward the midline. Eventually, using implants that are too wide will create rippling, palpability of the implants and a shape that is not nice.In short, how much fullness you can gain toward the midline is limited by how much fullness you can add to the side (unless the implants are placed off-center,which would distort the orientation of the nipples). As it is normally said, it is your original anatomy that dictates the final shape.

I have a wide sternum bone could anything could of been done differently to correct that just A LITTLE TINY BIT MORE? (photo)

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