How Do I Avoid Getting a "Refund Gap"?

I am scheduled for a breast augmentation on the 20th of this month with Dr.Guerra in Scottsdale,Az. Iv been wanting am augmentation for years but my biggest concern is ending up with a "refund gap" you know, the abnormal amount of space between breasts. What causes this?! How can i explain my concern to my doctor? Im 5"2 and 110 lbs, currently a 32B, looking to go to a 32DD. Thank you.

Doctor Answers 19

Increasing cleavage

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

A Refund Gap?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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?"

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 83 reviews

Spacing between the breasts post surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

You might also like...


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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.

Gap Between Breasts?#breastimplants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 54 reviews

A wide breast bone causes a wide gap between the breasts

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question. The main determining factor for having a wide separation between the breasts is a wide breast bone. Trying to narrow that distance by putting the implants closer together makes the breasts look abnormal and increases the risk of rippling in that area. 

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 40 reviews

You body shape will dictate the gap

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 153 reviews

Avoidance of "Refund Gap" Post Augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The term "Refund Gap" is not one that I have heard before, but you indicate that it refers to abnormally wide space between the breasts. Everyones breast/chest anatomy is different, and some individuals have a wide space between their breasts before augmentation. While breast implants do improve cleavage, their are limitations (based on your anatomy) to how far the cleavage can be enhanced. If, in an attempt to create more cleavage, a surgeon uses an overly large or wide implant, or overdissects the implant pocket towards the sternum, then the patient can end up with synmastia - a difficult problem to correct.

Another concern is that patients with naturally wide spaced breasts, the nipple can be located or directed more outwards. If an implant is then placed more towards the inside of the breast (in an effort to create more cleavage), then the nipple will rotate even further out and look quite abnormal. It is important to have the implant centered behind the nipple position.

The bottom line is that your own anatomy dictates to a large extent what the final result will look like, and implants cannot change things such as nipple position, or the location of your breast on your chest wall.

The refund gap

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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.

How Do I Avoid Getting a "Refund Gap"?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.


Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.