Pseudoptosis and a wide sternum - What is the best implant: placement, model/type and size? (Photos)

Question

I have Pseudoptosis & Wide sternum , I am 75C. I am decided on an implant, while I want to avoid over the muscle as well avoid waterfall deformity or baloon look. I want to acheive a natural look with a slide and a full cleavage, and hopefully reduce the boney space between breasts. What is the best implanet: placement, model / type , and size

Daniel Barrett, MD · Answer

Dear Raya90,

breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Kadir Berat Oyur, MD · Answer

Based on the photos, you appear to be a good candidate for breast augmentation, although your pseudoptosis and naturally wide sternum should be carefully considered during planning. A dual-plane implant placement is often an excellent option, as it can provide a natural appearance while reducing the risk of a waterfall deformity. Implant width and base diameter are generally more important than volume alone when trying to improve cleavage. While implants can enhance fullness, they cannot completely eliminate a naturally wide bony breast gap. A detailed examination and measurements are essential to determine the ideal implant type and size for your anatomy.

Donovan Rosas, MD · Answer

It is important for patients to understand that augmentation will "augment" all aspects of your anatomy. The spacing of the footprints of the breast on the chest wall will vary from one individual to the next. Widely spaced breast will appear more widely spaced and vice versa. 
The spacing (cleavage) is defined by the pocket. The pocket is defined by the plane of augmentation.When placed submuscular, the medial/middle limit is the sternal origin of the muscle. Wide sternum  greater separation of the breasts  less dramatic cleavage. This space can be narrowed (with some risk of synmastia) when the devices are placed subglandular or "over" the muscle. There is no muscle obstructing a medial push, however, there is a higher risk of over-dissection and midline migration of the implant (the dreaded "uni-boob").
With regards to your specific question, a higher profile device is narrower but will project more. A wider device can create the illusion of closer spacing between the breasts (when placed subglandular). Most patients will fit into the "moderate +" category...but this will depend upon the measurements of your breast width. That being said, it is never recommended that you stray far from your unique BWD.
And remember...love the look you choose...not the cup you desire.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Semih Yildiz, MD, FEBOPRAS · Answer

From your photos, the wide space between the breasts appears to be partly from your chest wall and breast footprint. An implant can improve fullness, but it cannot safely erase a naturally wide sternum. If the pocket is made too far toward the middle or the implant is too wide for your base, the risks are symmastia, visible edges, malposition, and an unnatural look.

For a natural slope and to reduce the risk of a balloon look, many patients with your goals do best with a smooth round silicone implant in a moderate or moderate-plus profile, sized to match the measured breast base width and soft-tissue thickness. A dual-plane placement is often useful when there is enough tissue but some pseudoptosis, because it can give upper-pole softness while allowing the lower breast tissue to redrape. However, if the nipple sits too low or there is true skin excess, an implant alone can worsen a waterfall appearance; a small lift may be needed.

The best size cannot be chosen from photos alone. Your surgeon should measure base width, nipple-to-fold distance, skin stretch, and sternal anatomy, then use sizers or 3D planning. I would avoid choosing an overly large or high-profile implant just to create cleavage.

Ted Eisenberg, DO, FACOS, FAACS · Answer

Choosing the right size and profile breast implants for you under the muscle for a natural look. I recommend an in person evaluation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Gary M. Horndeski, MD · Answer

Unfortunately, the wide sternum means that the footprint of the breast is widely separated. Placing implants in front of the muscle can decrease the width of the sternum. However, you are very thin and have very little breast tissue. An alternative for you to consider is fat transfer. This can be done to create more medial fullness and create more upper breast fullness. Fat transfers are usually good for about 1/2 cup to 1 cup size change.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Zoran Potparic, MD · Answer

You seem to be a good candidate for breast augmentation whether dual plane (underneath) or subfascial (over) the muscle. My recommendation would be round, moderate profile implant. Size is something that you will have to discuss and decide with your  surgeon. I hope this helps. Good look.

Ram Kalus, MD, FACS · Answer

Thank you for your questions and photos. An examination in person is required to properly and specifically advise you, but based on the information provided you would be best served with a proper width, minimal projecting implant in the subfascial (above the muscle) placement.

Do your research and consult with an experienced board certified plastic surgeon whose results and reviews resonate with you. Best of luck to you.

Do your research and consult with an experienced board certified plastic surgeon whose results and reviews resonate with you. Best of luck to you.

Pseudoptosis and a wide sternum - What is the best implant: placement, model/type and size? (Photos)

Answers (8)

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