How Do I Avoid Getting a "Refund Gap"?

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. 

Thank you for the question.

It will be important to communicate your goals with your plastic surgeon carefully. In my practice, I find that this communication is enhanced with the  use of goal pictures. Show your plastic surgeon examples of cleavage areas that you like versus those of what you do not like. Keep in mind, that the space between the breasts will largely be determined by your own anatomy. Other factors that will come into play will be the pocket dissected for the breast implant and the size/profile of the breast implants selected.

 Best wishes with your upcoming surgery.