Are my implants too far apart? What can I do? (Photos)

Question

I have had implants for 8 years. They are under the muscle and I've breast fed 2 kids so they are very settled. I've read it's got to do with my anatomy but I can't find any photos on the web that look as bad as mine. I've never been able to show the off and have always been embarrassed about them.

Tom J. Pousti, MD · Answer

Thank you for the question.  Your breast implants seemed to sit  appropriately behind each nipple/areola complex.  In order to achieve closer breast implants, revisionary breast surgery utilizing larger breast implants (possibly along with capsulorraphy)  would be necessary.  Some general thoughts may be helpful to you:Generally speaking, every patient undergoing breast augmentation surgery should understand that their anatomic starting point will limit the outcome of breast augmentation surgery. More specifically, every patient's anatomic starting point will to some degree determine how much space will be present between the breasts after breast augmentation surgery.  Other factors involved include careful breast implant pocket dissection and careful selection of breast implant size/profile.  Remember (when it comes to breast implant pocket dissection and achievement of ideal breast implant cleavage) that each nipple/areola complex must be centered on each breast mound.
 
Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural” or "C or D cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this (and the attached link, dedicated to this type of revisionary breast surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Damien Grinsell, MBBS, FRACS (Plast) · Answer

Hi. Your implants do seem to be a bit widely spaced which may either be due to technical factors with the initial augmentation or the muscular movement over time stretching the outer pocket. This can be improved relatively easily. The real issue is when to have the revision surgery. On average implants last about 15-20 years so if you can wait a few years the the implants could be replaced at the same time. Regards Damien

Mark Hanikeri, MBBS, FRACS · Answer

Hi and thanks for sharing your photos and the question.  You have a very common problem which tends to occur more with smooth round implants in a submuscular position than with textured implants, though it can happen with both.  It is called lateral drift of the implants and it occurs due to the force of contraction of the pectoralis major muscle, stretching the outer pocket and allowing the implants to slide sideways, especially when lying flat.  It occurs more with people who are quite stretchy, with larger implants, with smooth implants, with those who excessively massage their breasts in the early post operative period, with excessive pectoralis major contraction (Gym junkies) with overdissection of the lateral pocket by the surgeon as tends to happen with axillary approach breast augmentation or with just plain bad luck!
It may be corrected with excision/suture techniques combined with cautery burning to cause contraction/reduction of the lateral pocket whuilkst at the same time releasing the medial pocket to encourage medialisation of the implant. I usually combine this with exchange of implants for textured if smooth implants were previously used.  Unfortunately it can recur in individuals who are prone top the problem. I don't believe you necessarily need to go for larger implants if the above manoeuvres are utilised and larger implants may worsen the problem in prone individuals. 
You should discuss this with the surgeon who performed the procedure as this also serves as feedback to them about their own work.  Alternatively, see a Specialist Plastic Surgeon in your own city.
I hope that helps.
Kind regards
Mark Hanikeri MBBS, FRACS
Perth Specialist Plastic Surgeon

Ronald A. Lohner, MD · Answer

In general, patients vary in terms of their anatomy, so numerous factors must be considered when choosing implants, pocket selection, etc.  Most of the time, submuscular implants tend to be wider than subglandular devices given the same implant.  Selection of implant volume, projection and width are critical to obtain the best result.  Talk to your plastic surgeon, or contact an experienced board certified plastic surgeon for a consultation to see whether any options are available to you to improve your appearance and alleviate your concerns.  Best of luck.

Are my implants too far apart? What can I do? (Photos)

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Are my implants too far apart? What can I do? (Photos)

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Answer: Separation of breast implants

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