Could this big gap between my implants be fixed? (Photo)

Question

I had 380 cc ultra high profile implants put in in September 2023. I mentioned to my surgeon not wanting a huge gap but unfortunately I now have a huge gap. They fall to the side when I lay down and cleavage is impossible, even with a push up bra. Could different implants improve the look? Posting my before pics as well. My pregnant and breastfeeding boobs had no gap so I don’t know why I have the gap now

Gianfranco Frojo, MD · Answer

You may potentially benefit from tightening the pocket laterally and below. This would be done with releasing the pocket superiorly (capsulotomies) to permit placement of a more moderate profile but slightly larger implant. I would recommend performing thermal and suture capsulorrhaphies (tightening the internal pocket with heat and sutures). This would then be reinforced with some type of mesh or scaffold to provide extra strength for implant support. This would be a challenging case and needs to be tackled by an American Board of Plastic Surgery certified surgeon with extensive experience in revisionary breast surgery.

Matthew S. Kilgo, MD · Answer

Hello and thank you for your question.Based on your pre- operative photos , you had a fairly wide iintermammary distance, ( width of the breast gap) prior to your procedure. It is very difficult to change this dimension with implants. Attempts to create cleavage with an implant can lead to unwanted complications, most notably symmastia, which is very difficult to correct. My suggestion would be to consider a lower profile implant in addition to fat grafting along the inner portions of your breasts to increase fullness in those areas. I would recommend finding a surgeon certified by the American Board of Plastic Surgery who has extensive experience and revision breast surgery. I hope this helps. Good luck.

Gary M. Horndeski, MD · Answer

At this time, I recommend a circumareola approach to reposition the nipple-areola complexes more medial and you will need plication of the pockets laterally and inferiorly. You also need lower profile implants placed that will fill the gap and improve your cleavage.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Exuberant446775,
many women seek improved cleavage. Narrowing the cleavage plane can be done very carefully by a skilled surgeon. Moving the implants too far medially can result in synmastia or unaboob which is very difficult to correct. That being said, the right amount of pocket dissection and implant selection can create excellent cleavage. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ira H. Rex III, MD · Answer

The width of your cleavage is mostly determined by your own anatomy and how your tissues are put together.  If your implants are under the muscle, this definitely determines width of the gap.  The gap cannot always be managed precisely because of many factors.  It seems you have and excellent result!  Hope you enjoy it.

Shlomo Widder, MD · Answer

Dear Exuberant,
         Thanks for posting your photos and sorry for your sub optimal outcome. From observing your pictures the following problems are noticed : 1. Right breast bottomed out and requires inferior capsulorrhaphy - internal bra, to raise up the infra mammary crease. 2. Left breast will need inferior capsulorrhaphy as well in order to even up the  submammary creases and mini lift to even up the nipple location. 3. Wide cleavage requires medial capsulotomy (scar release) and further dissection of the muscle towards the midline , which will create nice cleavage. 4. From your description the implants are displace laterally when you lie down. Lateral capsulorrhaphy  will solve that problem and help to improve further the cleavage.
    Always consult with experienced  board certified plastic surgeons who operate in accredited surgery center for your safety.  Most importantly, check the before and after pictures of redo breasts augmentation in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.
               Best of luck,
                                 Dr Widder
                     widderplasticsurgery.com

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion of my practice is dedicated to revision breast surgery.  I have been in practice for 30 years and have fixed hundreds of cases similar to yours.  In fact, I wrote the very first paper on capsulorrhaphy, otherwise known as an internal bra.  You should be able have an excellent result.  Best wishes to you.

Farbod Esmailian, MD · Answer

Thank you for posting the preop photos.  You anatomy is very challenging because of the way your ribs are shaped and your breast are spaced apart.  You can tell this by looking at your nipple areola complex and see how it is pointing to the side.  
With your implants going off to the side when you lay down, it appears that you have some lateral displacement which does not help either.  The lateral pocket needs to be closed down, capsulorrhaphy, +/- mesh, the medial pocket needs to be opened up as much as possible without violating the pectoralis muscle and a wider implant than the ultra high profile that you currently have needs to be placed.

Hope that helps.

Connie Hiers, MD, FACS · Answer

Actually, you did have a gap before implants. With implants behind the muscle, the gap cannot be minimized and the muscles tend to push the implants outward. Your lateral pockets could be tightened, but I do not recommend changing your implants in front of the muscle for you will see the edges clearly.