Is There Any Way to Get my Breasts Closer Together Without Going Back Under the Knife?

Question

I'm two weeks post-op. I went from a 32AA to a 32C. I had 400cc silicon implants placed under the muscle. My doctor said that I had very little breast tissue and one of my natural breast is slightly larger than the other before the surgery. My breasts are now far apart and my left breast also hangs lower than my right. Are there any type of sports bra that can bring them closer together. I noticed that they are further apart when I get up in the morning after lying on my back all night.

David A. Bottger, MD · Answer

Developing an optimum amount of medial breast fullness is often difficult in women with minimal breast tissue and I don't think it is related to your implant positioning which seems appropriate. The implants are situated behind the pectoralis muscle and cannot be moved closer together or they would disrupt the origin of the muscle on the chest wall and create potential deformities. Unfortunately, with minimal breast tissue patients, a wider space may be apparent between the breasts which is unavoidable. I would recommend a standard sports bra during the first month In general for support but I don't think this will produce any significant "movement" of the implant position. Expect the implants to drop slightly in the vertical direction over the next month or two.

Richard J. Bruneteau, MD · Answer

The vast majority of patients who undergo breast
augmentation consider cleavage to be an important component of an aesthetically
attractive breast.Unfortunately,
patients sometimes present with anatomic constraints that limit how much
cleavage can be obtained with this procedure.When patients have laterally sloping chest walls and laterally
positional nipple areola complexes, cleavage isn’t always possible.Efforts to create cleavage by moving implants
in an unusual direction can often result in secondary deformities. Your
pictures suggest relatively good positioning of your implants.They’re centered properly beneath the nipple
areola complexes.With resolution of
swelling and muscle spasm, you might ultimately be happy with your result.For these
reasons, efforts to move your implants in a medial direction, either with a
support bra or additional surgery, are not indicated and could have negative
consequences.It’s important to discuss
these issues with your plastic surgeon.Your surgeon should be able to address your concerns.

David Stoker, MD · Answer

It is likely that the midline border of the pectoralis major muscle will determine how close together your breast will be. Using a support bra that pushes the implants toward the midline, especially within the first few weeks following surgery, may help you to achieve your desired result. Patients should discuss this with their surgeons before moving the implants.

Michael M. Omidi, MD, FACS · Answer

Thank
you for the question.  You are still too early in
the post operation recovery stage. It usually takes about 8-12
weeks for the wounds to heal and around 4-6 months for the implants to fully
settle.  It would be best to visit your
board-certified plastic surgeon and get a full assessment if you are unhappy with the results after 6 months.  Best of luck. Dr. Michael Omidi.

An
in-person exam with a board-certified plastic surgeon is the best way to assess
your needs and provide true medical advice.

Vasdev Rai, MD · Answer

With submuscular implants the cleavage is always seperated by Sterum (chest bone). To achieve natural close cleavage, implants need to be subglandular ( in front of muscle). All natural breasts are developed in front of muscle and thus enjoy a close cleavage. Surgical breasts with implants behind the muscle are seperated from each other in a deeper plane of body, which itself is seperated on right side and left side of body by Sternum (Midline chest bone). No special bras will achieve what you seek. Since you have very little breast tissue of your own you may not be candidated for subglandular implants. In that case you should learn to accept limitations of surgery in your particular case and be happy.

James Nachbar, MD · Answer

Two weeks is far to early to evaluate the final appearance of your surgery.  However, my guess is that your "cleavage" will probably not improve very much.   With implants under the muscle, moving them closer to the center would tend to separate the origin of the muscle from the ribcage, and with so little tissue at the inner part of the breast, the central separation will not likely improve.

	But look at the swimming suit catalogs -- beautiful breasts come in a very wide variety of shapes.  Cleavage is not required.

Steven Wallach, MD · Answer

Cleavage obtained after implants is dependent on several things, most importantly your original anatomy. If you have a very wide chest to begin with, then in all likelihood it will be that way after surgery. Sometimes wider implants can help.

Fereydoon S. Mahjouri, MD · Answer

Thanks for posting your photo . It appears that your 400 ml. implants are sligthly too large for your frame which enhances the distance between your nipples . If you review your before surgery pictures you will find out that your breasts were formed naturally apart.from each other. Your surgeon has done a great job of positioning your implants in proper place ( center of implants exactly under your nipples) . Do not try to move your implants closer together to have a nicer cleavage. Garment or taping will not do, and evenif it happens your nipples would not be sitting at the center if implants & your breast would look funny. When choosing bras , pick up the types which has low &lateral under- wire cups. You will be amazed how helpful they are.

Aaron Stone, MD · Answer

For optimal breast aesthetics we like to have the line between the notch above the breast bone and the nipples and another between the nipples themselves form an equilateral triangle. Then we want the breast tissue and implants centered under the nipples. In your case the internipple distance (base of the triangle) is slightly longer than the other 2 sides of the triangle but the nipples still point straight forward. When the base of the triangle becomes very long the nipples point out to the sides. Your implants look centered under the nipples horizontally and the 2 sides are close to symmetric but the implants are just a bit high of center in the vertical dimension. This will likely settle down with time and gravity.

	Breast implants cannot create cleavage if it did not exist prior to their placement. Since you were an AA cup you did not have cleavage before surgery and so cannot get it afterward. The base of the triangle could have been decreased at the time of surgery by medial crescent mastopexies to give the illusion that the implants are closer together. This however would have given you some additional skin scarring. Your current result is about as good as could be expected given what you started with. The final result is dependent on the amount of natural breast tissue vs. implant material and how well the natural tissue covers the implant among other factors. Since you are early after surgery the implant position is still shiftable so the best thing you could do is wear a bra most of the time. This will help with what you see as outward shifting of the implants while sleeping.

	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Brian Klink, MD · Answer

It looks like you had a fairly wide sternum/cleavage that was present prior to the augmentation. The chances of getting the implants closer without another surgery are pretty slim. The fact that they fall to the back when you lie down means that the lateral pocket is a little large. That pocket can be closed off and the implants can be a moved a little closer. However, moving them closer also means that you have some risk of more visibility of the inside part of the implant as the tissue is very thin. Good Luck

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