How Do You Avoid Implants Looking Very Gapped/far Apart from Each Other?

Hi I am seriously considering getting breast enlargement, Im currently and A and am in between choosing a large C or a small D. However, many pictures iv seen of before and after surgery shows that the womens breasts are quite far apart (large space between them) with no cleavage. I wanted tear drop breast implants but after reading have found out that they are more likely to cause rippling and wrinkling. I just dont want them to look like two round fake looking balls and not natural at all..

Doctor Answers 5

Avoiding Spreaders

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Cleavage is a widely variable anatomic state defined by how close the breasts on either side approach the midline.  During an exam, one can usually determine  where the breast tissue begins relative to the midline by compressing the breasts toward the breast bone, much like a push-up bra.  If it is greater than 2 cm then the intermammary distance is wide.  Usually in this situation, the entire gland and the nipple sit more laterally on the chest wall.  The goal with a well thought out augmentation, should be to place the implant with its peak centered behind the nipple.  If the the nipple and breast lie more lateral on the chest, then the implant will as well, causing a wider gap between  the breasts known as "spreaders" in blogosphere parlance.  A wider implant can be chosen to narrow the space between the breasts, but for every cm closer towards the middle the implant will also extend a cm laterally to keep the it centered behind the nipple.  This can cause an implant that partially sits under the arm.  The other option of simply placing the implant closer to the middle should also be avoided, as it may improve cleavage but result in a breast mound with the nipple located and pointing outward.  Anatomic varieties such as these can only be corrected so much.

Birmingham Plastic Surgeon

Avoiding "death valley" after augmentation

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is certainly something you should be concerned about if your breasts start out widely apart.  Your body determines what implant dimensions can be tolerated.  The thickness of your soft tissue also help determine how stark your augmented breasts will appear.  Regardless, some diminishment of your intermammary distance (space between the mounds) can be achieved with wider implants and conservative release of your tissues medials.  Over dissection can result in symmastia where your breasts can become one large mound in the center and you do wish to avoid this.  Discuss your concerns with your doctor and he/she should be able to help guide you through the decision making maze.

As mentioned earlier, tear drop implants filled with cohesive GEL are less likely to wrinkle.  Saline implants are simply the worst offenders when it comes to rippling and wrinkling, regardless of whether they are round or anatomic.

Finally, there is nothing natural about implants so if you really want natural, do not get them.  Implants are guaranteed to make you fuller and larger, but not natural.


Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Getting a natural look

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Here are a couple of tips for you:

Go to a plastic surgeon that measures your frame, and uses this information to help you select a proportionately sized implant.  Some people call this "anatomic sizing", "proportional sizing", "dimensional", "high 5" - there are a number of related approaches. That way, the implant will "fit" your frame and look more natural.  

Avoid very large or very high profile implants in the subglandular position....unless you are actually going for the "big & fake" look.  To look more "natural", get a more reasonable size, and put the implant behind the muscle for a smoother chest to breast transition.  We use the "dual-plane" approach which works well


Best wishes! 

How to Avoid Widely Spaced Breasts

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Dear Helbelz,

One of the greatest myths in breast augmentation surgery is that we can more the breasts around on the chest like they are pieces on chess board.  A woman's breasts are secured in position on the chest wall by a series of structures that act like the foundation to support and hold the breast in place through the years.  Disruption of the foundation is asking for trouble later down the road.  In the 1990's, lots of plastic surgeons tried to move the breasts around by ignoring the support structures resulting in some very distorted breast shapes and positions.  Instead, using the breast's support system to help hold the implants in position seems to help maintain the desired shape for longer.

The most common reason for a woman having widely spaced breasts is the shape of her chest wall.   If the chest is very round, barrel-shaped...then the breasts will most commonly be positioned more lateral and with gravity, they will migrate more lateral with aging.  While implants may delay this process for a while, there is an old saying in plastic surgery that gravity always wins.

The effect of having an augmentation is with the larger size, there is more "breast" to move or shove with the bra or top than there was before.  So even women with very widely spaced breasts can have cleavage.

As far as the shape of the implant, there is very little evidence to suggest that a teardrop silicone or cohesive implant is more likely to ripple when compared to their round cousins.

Hope this helps.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.7 out of 5 stars 88 reviews

Breast Implant Position

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In many breast augmentation patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola. Ideally the implant should be centered directly behind the nipple-areola complex (NAC). In profile, the natural-appearing breast is not convex in the upper pole, and an excessively convex and overly full upper pole is a dead giveaway that a breast implant sits below the skin. In addition, inadequate release of the inferior origin of the pectoralis major will allow the muscle to hold the implant in too high a position, and may even cause the implant to displace upwards (as high as the collar bone in some patients) when the muscle contracts. Patients with this problem require reoperation to release the inferior origin of the pec major and/or the inframammary fold.

Likewise, if the inframammary fold is lowered too far, the augmented breast will appear 'bottomed out', with an excessively full lower pole, an empty upper pole, and a nipple/areola that appears to sit too high on the breast - another situation with a distinctly unnatural appearance, and one that requires surgical correction: repair of the inframammary fold(s).

The horizontal position of breast implants also requires a great deal of attention, both in pre-operative planning and in the operating room. Excessive lateral dissection of the implant pockets will result in augmented breasts with an excessively wide space between them in the cleavage area, and the appearance that the breasts are abnormally far apart. The result may (or may not) be tolerable in the upright standing or sitting position, but when the patient lays down in supine position (on one's back) the implants may fall far to the side and produce little to no anterior breast projection in this position. Patients with the problem almost always want it corrected, and the treatment once again is surgical: a lateral repair of the implant space, to restrain the implants from falling off to the side.

Inadequate lateral dissection, on the other hand, will result in an augmentation with an abnormal 'side by side' appearance. It is lateral projection of the breasts beyond the lateral border of the chest wall (in frontal view) that, along with the concavity of the waist profile and the convexity of the hip profile, produces the appearance of an 'hourglass figure'. While one does not want to over dissect the lateral extent of an implant pocket, careful attention must also be paid to ensure that lateral breast projection is not inadequate.

Breast implant base diameter is also of crucial importance. The base diameter (the side-to-side dimension of the implant) must be ideal for the existing horizontal dimension of the breasts preoperatively, as well as the breadth of the anterior chest in general. Obviously, a given implant volume and base diameter that works well for a small-framed patient that is 5'3" will be completely inadequate for a broad-chested patient who is 5'10". One wants to increase cleavage area fullness and lateral breast projection in most cases, and an implant of inadequate base diameter may accomplish only one of those goals, while too wide an implant will be overprojecting in both directions. Careful evaluation of all of these breast and implant dimension issues is necessary if the ultimate goal of the surgery is a natural-appearing breast augmentation.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 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.