Breasts in Armpits, Large Gap Between? (photo)

Question

6 months post op. High profile saline implants were used, 380cc on left, 450cc on right side. My breasts are now getting in the way if my arms and they have a huge gap in between. I have to wear both a bra AND a bra like garment that pushes them together. I have waited 6 months to see if the situation improved before talking to my surgeon. My surgeon says that my sternum is too wide to put them any closer. I am concerned about asking her to fix it. Plus, I am concerned that she doesn't know how.

Jason E. Leedy, MD · Answer

Preoperative education is key to any plastic surgery procedure. It doesn't necessarily look like anything is wrong with your result, it simply looks like the result that I would expect given your preoperative breast shape and the size of the implants that were used. The shape of the ribcage and sternum impacts the final position of the implants. If the sternum is prominent and the chest wall angles to the sides, then the implants will follow and result in a more pronounced space between the breasts. Not much can be done about this. Larger implants, particulary high profile saline implants, will result in some stretching of the lower pole of the breast which you have. If you are unhappy with your surgical result you should discuss this with your surgeon. Improvement in your breast shape would likely require removal of the implants, replacement with smaller implants (likely silicone), and a breast lift with an anchor-type incision. Every choice carry consequences and it is important to determine what final shape you are really looking for and make sure you convey that to your surgeon. Good luck.

Ryan Neinstein, MD, FRCSC · Answer

Lots of information here, sometimes revision surgery works and sometimes it makes things worse. You really need to think about how much time,money, and energy you want to put into this!

Edwin C. Pound, III, MD · Answer

An implant is designed to add volume to the breasts, nothing more.  It is not designed to change the basic shape of the breast.  Looking at your before and after pictures, it appears that you had a fairly wide cleavage before your surgery that did not change afterwards.  This is because you have a very wide chest bone.  If you feel over that chest bone you will feel skin and bone.  I have seen patients who have come through my door where a doctor has tried to give them better cleavage by undermining the skin over the chest bone.  Only bad things result from this.  First, there is very little tissue coverage over the implant and any little ripple/wrinkle can be seen/felt in this area.  Secondly, the implant is not centered behind the nipple/areola but rather more towards the middle of the chest.  This results in the nipples pointing towards opposite walls.  For patients with a wide chest bone, I usually don't mess with trying to give them more cleavage using an implant.  That is the purpose of push-up/push-in bras. 

	Now, if you lie on your back and your implants slide out into your armpits, that is a different issue.  In this case, there is not enough support for your implants laterally.  This may require a second surgery to tighten up the outside portion of the breast pocket so that the implants don't migrate outwards when you lie down.

Brian K. Reedy, MD · Answer

You are asking the right questions. Is your surgeon willing, but more importantly, is your surgeon able to correct this? Before you undergo any more surgery, seek out a second opinion. Make sure the surgeon is experienced in revisional breast surgery and ask to see pictures. There are several possibilities to improving your breasts. Without a careful exam and review of your pre-op pictures and operative notes its hard to specific. However, changing to a more moderate profile silicone gel implant, medial capsulotomy combined with a lateral/inferior capsulorrhaphy are some thoughts that come to mind. Hope this helps. Good Luck!

Otto Joseph Placik, MD · Answer

High profile implants have a smaller diameter at the base.  A moderte or moderate plus implant may help as well as changing the pocket.

Kenneth Hughes, MD · Answer

I would ask the plastic surgeon to help with your concerns. With your arms above your head, it is difficult to properly evaluate the results. If you would like a second opinion, I perform alot of breast augmentation revisions. Kenneth Hughes, MD Los Angeles

Steven L. Ringler, MD, FACS · Answer

Hi Maryanne, Thanks for providing pictures of your breast augmentation. I am sorry you are dissatisfied with your augmentation results. From what I can see, your implants are being displaced by the pectoralis muscle, and this can be corrected with surgery. Typically, this requires removing the implants, releasing the muscle close to the sternum, and in your situation, I would consider a slightly smaller implant with a wider base diameter (more of a moderate profile rather than high profile implant). This can be a risk with breast augmentation surgery. I believe your situation can be corrected for a more satisfactory result. Good luck to you.

Pablo Prichard, MD · Answer

Hi Maryanne,

	Thank you for your question.  There are always options for correcting the above problem.  In my opinion, the implant pockets need to be revised, probably a dermal matrix needs to be placed to support the new pocket and keep the implants from shifting, and textured implants can be used to help keep the implants from migrating and stay in a good position.  The gap can be closed despite a wide sternum and initial widely placed breasts, however, this is more work than a normal breast augmentation.  Seek a few opinions from board certified plastic surgeons.

	Best Wishes!

	Pablo A. Prichard, MD

Paul Wigoda, MD · Answer

I would suggest getting a second opinion. The way to fix it may vary depending on what was done in the original surgery. All of the different options discussed by the other surgeons are possible but which is best will depend on a physical exam and a history of what the first surgeon did. Are you above or below the muscle? As a side note, the width of the sternum is not a major factor. The separation that your breasts have originally, is a factor (those two are not the same thing). Best of luck.

Steven Wallach, MD · Answer

If your implants are laterally displaced, then you need to have capsulorrhaphies laterally to bring them more medially( toward the sternum)

Breasts in Armpits, Large Gap Between? (photo)

Answers (19)

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