How Do I Avoid Getting a "Refund Gap"?

The abnormal wide space between the two breasts can be reduced transposing the breast tissue medially.  This can be done through a circumareola approach.  There is a new technique called The Mini Ultimate Breast Lift and can be used simultaneously with a breast augmentation.  When placing implants retro-pectoral, it may be difficult to go from a 32 B to a 32 DD.

Best Wishes,

Gary Horndeski, M.D.

Post-operative cleavage will always be determined by the natural distance that exists between the inner edges of a woman's breasts and the distance between her nipples. When performing breast augmentation, although the implants can be cheated closer together a small amount, they still must be centered more or less beneath the nipples. Placing them elsewhere will lead to an unnatural appearance. This means that patients will have cleavage similar to their natural state even after their augmentation results become visible.  Therefore, looking at your natural cleavage can help you get a rough idea of how your cleavage will be after surgery.

"Refund gap" is a new one for me, but refers to excessively-wide cleavage. At your petite size and with your large-breast goal, your surgeon should have minimal difficulty helping you achieve your narrow cleavage look--with some anatomic limitations.

If your surgeon creates pockets that are excessively "close" in the mid line in an effort to achieve that "narrow cleavage" you seek, you could end up with symmastia (uni-boob), which is more common with large implants already. This requires expert surgical technique and care by Dr. Guerra.

Be careful during healing to not wear an overly-compressive bra (when your surgeon says it's OK), but one that supports without pressing your implants inward too hard; this can weaken or stretch the attaching fibers that keep your implant pockets separate and your cleavage attached to your breastbone. Good luck and best wishes! Dr. Tholen

The space between your breasts (intermammary distance) can be somewhat controlled by the type of implant that is used. In some cases, using a lower profile implant or one with a wide base width can help minimize this gap. However, there are certainly limitations in how close a surgeon can minimize this gap. Your chest wall anatomy will in large part dictate how close the implants appear after surgery. There are several things to be careful of when trying to narrow this space. If the natural adhesions of the pectoralis major muscle to the sternum are over-dissected, the risk of developing a synmastia are increased. This is when the implants look too close together and start to touch in the midline. Also, the position of your nipples is very important. If your nipples are set slightly laterally (toward the armpit), attempting to place the implants to far to the inside will make the nipples appear as if they are located on the outer edge of the breast. The implants should always be centered on your nipples to look natural and normal. 

Also, I would ask your surgeon about the wisdom of trying to increase your cup size from a B to a DD. Doing so will almost certainly make you appear unnatural. This is OK if that is what you want. But also think about the long term affects of unnaturally large implants. Your risk of needing a breast lift in the future will be increased at minimum. And permanent thinning of your existing breast tissue and skin will also be more likely. Bigger is not always better. In the end, it is your body and you will be the one who needs to be happy with the results of the surgery. I would just encourage you to think about all of the ramifications of your decisions both for the short and long term. 

Post-operative gap will be consistent with the natural distance that exists between the inner edges of a woman's breasts and the distance between her nipples. This post operative gap can be limited by the surgical technique and expertise of the surgeon. Choose an experienced and expert board certified plastic surgeon who understands your goals and objectives.

Miladoll, thanks for the question. I feel that good communication with your surgeon is always very important. I tell my patients that most of your cleavage is determined by your anatomy. The pectoralis muscle attaches to the breast bones on either side at defined positions. This will largely set the tone for what kind of cleavage you will or can have. The other aspects are the profile of the implant and the dissection of the pocket. Communication is key with your surgeon and spending the time to really communicate is so very important. If you trust in your surgeon and feel that you have really together defined your goals you should have a great result. Aldo is a great guy,a great surgeon and he will treat you well.

Your question has been more than adequately answered by the experts here.  The question you will have to answer for all of us is "Where did you hear of the term Refund Gap?"

You have chosen a great surgeon and he can answer your questions after examinations. The gap depends on the anatomy and implant position. 

We're all lifetime learners and now we've learned something new---I had never heard of this phrase and thought it referred to a cancellation penalty. The gap is based on your own anatomy and the distance between the breasts. Implant selection can be a factor and going from a B to DD, if you do have a gap to begin with, will highlight the gap even more. Discuss the sizing and your concerns with your plastic surgeon in person.

I have never heard that expression before! It describes the wide space between the breasts. When you see this in post-op photos, the commonest cause is pre-op anatomy. When patients breasts are far apart before surgery, they will be far apart after surgery. The implants are centered according to breast location. If they are placed more centrally than is the breast, the nipple and areola will be on the side of the breast, a finding that is quite bizarre looking, and certainly less attractive than more widely spaced breasts which are a natural variant. 

Choice of implant size and profile can allow for more central fill, with some limitations. Women with widely spaced breasts may consider implants placed above the muscle in some settings, as the sub pectoral position limits the amount of central fill. Placing the implants too close, especially for large implants, can cause symmastia, where there is no separation between the breasts. This is most unattractive, and difficult to treat. 

Thanks for you question and best wishes. Be sure to discuss your concerns with your surgeon.