Why is my breast gap so large? How can this be improved? (Photos)

Question

have always been petite at 5’3” and around 112 pounds. About a year and a half ago, I had breast augmentation. I started as a large A to small B cup and chose 285cc implants placed over the muscle to reach a C cup. Since then, I feel like the implants have dropped. I have very little cleavage, and even when I wear a deep V or low cut top, my chest still looks flat. I am trying to understand whether this is due to my natural body frame, the implant size, or the placement. I am wondering if something went wrong with the placement or if this outcome is typical for my build.

Zoran Potparic, MD · Answer

This problem is very likely due to your existing anatomy, at least based on these photos. Even with your preoperative photos available, it would be difficult to find exact set of reasons without in person evaluation. Significant correction can be achieved with fat grafting medial and upper aspect of both breasts. You will need in person consultation with a board certified plastic surgeon with experience in this technique. Good luck.

Ira H. Rex III, MD · Answer

Often, but not always, the cleavage is certainly determined by your own anatomy.  Your observations seem very accurate and the best way to proceed at this point would probably be to see a plastic surgeon.  Hopefully, you could see your original plastic surgeon.  They would probably be able to sit down and discuss with you and your findings and what may be surgically done to better suit your expectations.

Leila Kasrai, MD, FRCSC · Answer

Breast implants are centred behind the nipples, therefore cleavage can only improved to a certain extent. Generally speaking, patients with a large gap before surgery continue to have a large gap afterward. However, if you have noticed that the gap has increased as time passes, you may want to discuss this with your surgeon.

Brian K. Reedy, MD · Answer

Thanks for your question! Your implants have stretched in the lower pole and probably laterally (although its hard to tell in pictures). By performing a capsulorrhaphy and perhaps going with a slightly wider implant, you should be able to get better cleavage. Good luck!

Luis A. Mejia, MD · Answer

In my opinion, the best recommendation is a revision to a slightly larger, higher-profile implant placed in a dual-plane (under-muscle) position. This provides better medial fullness and cleavage while still looking natural on a petite frame.

Whenever you’re ready:
Let’s make it better.

Warmly,
Dr. Luis Mejía, MD
Board-Certified Plastic Surgeon
CECILIP, Dominican Republic.

Whenever you’re ready:
Let’s make it better.

Warmly,
Dr. Luis Mejía, MD
Board-Certified Plastic Surgeon
CECILIP, Dominican Republic.

Jacob Carlson, MD · Answer

The most likely reason the implants have dropped in position is the placement in the subglandular position. When implants are put on top of the muscle and fascia, the weight of the implant is supported only by the breast tissue and skin. 285cc is not a “large” implant, but it seems that it was more weight than your breast tissue is able to support on its own. With the stretching of the tissue, the implants gradually drop in position. The space between the implants could be due to the same process or could be due to the dissection that was performed during surgery. A surgeon could perform a capsulorrhaphy to reposition the implants. The implant could also be moved to the subfascial/submuscular position – with that option, a surgeon might determine that a lift is needed as well, but I would recommend speaking to a surgeon in-person for that to be evaluated appropriately.

Gary M. Horndeski, MD · Answer

Unfortunately, you have not provided your before photographs. It may have been your breasts were widely separated to begin with. Adding implants made the situation worse. At this time, I recommend explantation with breast lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. A large portion of my practice is dedicated to revisionary breast surgery. The term internal bra refers to capsulorrhaphy or suturing of the pocket. I wrote the very first paper on this in 1999. I perform this surgery multiple times per week. Generally, this is a straightforward procedure that should lead to long lasting results. There are many plastic surgeons are not well versed in performing the capsulorrhaphy correctly, and these are prone to failing. Make sure that you interview multiple surgeons who have considerable experience in breast revision. Best wishes to you.

Harry T. Haramis, MD, FACS · Answer

Space between breasts (cleavage) depends on your anatomy, unfortunately, wide space can be filled in to a degree with implants, but will not touch without breast distortion to the sides.

Implants can descend lower as they settle, taking away from the cleavage area. This can be restored by revision surgery, reinforcing the fold thereby raising the implants higher and filling in cleavage area as they were initially. In some cases, mesh may be indicated for better, longer support.

An exam and consultation with your/a plastic surgeon is recommended to discuss your options and expectations.

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).

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