Breast Augmentation Redo to Bring Breasts Closer Together?

Question

Hello. I had a Breast Augmentation 5 years ago they are 300cc mentor round saline implants that are under the muscle. They are very far apart and flatten out when my arms flex.

	I would like to get them redone so I can have some cleavage. Is this possible because my areolas are very far apart naturally and I have a very round ribcage. I want a wider closer together breast without have a lot of projection Is this all posible?

Richard J. Bruneteau, MD · Answer

Cleavage is one of the characteristics that’s associated
with physically attractive breasts.For
this reason, it’s not unusual for patients to desire this anatomic
feature.Unfortunately, this isn’t
always possible because of specific anatomic restraints that patients may have.Your
pictures suggest several areas of concern.These include a lateral sloping chest wall, lateral displacement of your
breast tissue and laterally positioned breast implants.Although,
you might benefit from medial re-positioning of your breast implants, this
might not entirely accomplish your aesthetic goals.It’s important to realize that breast
implants need to be centered beneath the nipple areola complex to avoid
secondary distortion. It’s also important to realize that underlying chest well
abnormalities can impose limitations on your final result as well.Under
these circumstances, re-positioning your breast implant would significantly
improve your aesthetic result. Unfortunately, the amount of cleavage would be
limited by the lateral position of the breasts and the shape of the underlying
chest wall.If
you’re considering revisional breast surgery it’s important to consult a board
certified plastic surgeon. This surgeon
should be able to formulate a treatment plan that addresses your anatomic
findings and achieves your aesthetic goals.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Ms. JKimmel,
Sometimes women can have reshaping of the internal aspects of the pocket (capsule) and/ or a wider implant can be used. What is important is to try to place the implant so that the nipple-areolar complex is centered on the implant. If you have widely spaced nipple-areoar complexes due to a rounded chest shape it would throw off the relationship between the implant and the nipple-areolar complex if the implants are placed closer together. It may not be possible to increase the fullness in the cleavage area in theses cases.
I hope this helps.
Dr. ES

Farbod Esmailian, MD · Answer

You can definitely have an improvement.  However, one needs to be careful not to over do it as you have mentioned is that your nipples are far apart.
The key is to center the implant just under your nipple and areola complex.  So yes the implants need to be moved over a bit by a capsulorrhaphy and center under your NAC, but they will still be some what far, closer than they are now and better looking but still you will not have a lot of cleavage, and that is secondary to your anatomy.
Hope that helps.

Armando Soto, MD, FACS · Answer

Hi there-

	There is no question that your result could be improved. I would visit with a few Board Certified Plastic Surgeons, discuss your goals, review photos of their work in situations like yours, listen to their plan to correct this problem for you, and decide based on your understanding of their ability to achieve your goals.

	I am not a believer that your nipple position would limit your outcome, but do agree with Dr. Rand that form the photo you posted it looks like you need significant pocket corrections to be made, with a broader base diameter implant.

	Need help finding a surgeon? Please read this:

Otto Joseph Placik, MD · Answer

As Dr. Aldea and Rand have stated, you can obtain an improvement. I have also found that many patients develop this appearance after pectoralis strengthening exercises that displace the implants to the outside of the chest. following repair I frequently advise patients to avoid these activities such as wide stance push ups, bench press, and butterflies or the "pec deck." In the past, textured implants were used to keep the implants in place but these are not popular in the US. Essentially you would benefit, in my opinion, from silicone moderate plus profile implants with medial capsulotomy and lateral capsulorrhaphy.

Raj S. Ambay, MD · Answer

Getting the implants closer together is certainly possible but creating cleavage where where you not have had any or enough is very difficult and risky. Your issue is not simple and I recommend you speak with a plastic surgeon and have a complete examination of both the implants and your chest wall.

Tom J. Pousti, MD · Answer

Much of the final &ldquo;look&rdquo; achieved after breast augmentation revision surgery  depends on several factors:
	1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation &ldquo;look&rdquo; will be optimal.
	2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.
	3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
	On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
	Other differences involve how the breast implants are filled. Saline implants are filled after they&rsquo;re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
	On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers&rsquo; saline-filled breast implants are considered investigational. As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
	4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; or "fake looking" means different things to different people and therefore prove unhelpful.
	Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate. I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. By the way, the most common regret after this operation, is &ldquo;I wish I was bigger&rdquo;.

	 I hope this helps.

Tal T. Roudner, MD, FACS · Answer

Looks like yo have done your homework !

	You are right, when your chest anatomy is rounded or has a pectus carinatum (pigeon chest) appearance it does tend to place the breast and the nipple areolar complex more lateral. That will separate breast apart and decrease the "cleavage". Breast implants of the right size, width and projection can improve this problem to a certain degree in an unaugmented patient. It is important to choose the right implant for the right patient. Thin patient's with minimal to moderate breast tissue can not tolerate large implants due to the increased width of the implant and subsequently visibility and palpably of the implant and so the correction of the "cleavage" is limited by those factors.

	In a patient that has been augmented (like you) and the implants were originally placed to laterally a correction of the pocket needs to be made such as re suturing the later part of the capsule and medialzing the implant but that is tricky since it may push the nipple areolar complex more laterally.

	A better way is to actually create a new pocket "neo-pocket" and adjust the placement of the implant accordingly. New elements such as the new biological acellular dermis used as internal bras can be help full as well.

	Good luck

Juan A. Brou, MD · Answer

You naturally have a large separation between your breast. This has been exagerated by the lateral displacement your implants experience from the pectoralis action. This can certainly be improved surgically by a combination of using a better choice of implants (Larger, less profile) and capsular correction (closing the lateral expansion of the capsule and probably releasing the capsule medially) Even though the appearance will improve there will still be a fair amount of separation because that's the way your chest is shaped.

Steven Wallach, MD · Answer

Cleavage is sometimes hard to give to patients that anatomically did not have it before. You can cheat it a bit by using wider implants, and making sure that the implants are not falling off to the sides by tightening the lateral capsules.

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