Breasts in Armpits, Large Gap Between? (photo)

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.

Doctor Answers 20

Large gap and implants in armpits?

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

Phoenix Plastic Surgeon
5.0 out of 5 stars 47 reviews

Implants in armpits

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.

Paul Wigoda, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Breasts laterally displaced

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

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Breast augment revision

I think you will need the breast pockets revised.  I am not personally a fan of high profile implants because they can contribute to the problem you have in terms of the "gap"; moderate profile would be a better solution.  Since people don't walk around with their hands over their heads regularly (unless they are under arrest) a photo with your hands at your sides would be much more helpful in evaluating your condition and making a recommendation.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 39 reviews

Breast augmentation revision

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.

Jason E. Leedy, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 126 reviews

Wide cleavage can be corrected

The images presented are a bit hard to interpret because the arms are up, however reading the description it appears that the implants may be a bit too small in base diameter. 

In addition, implants that are placed under the pec muscle move with the muscle contraction and may be pushed to the side.

This problem can be resolved by replacing the implants with a better suited implant type and correction of the muscle and pocket shape and size.

I would recommend a personal consultation with a surgeon experienced in this kind of revision, discuss your personal expectations and review the surgeons results with this procedures.

Best wishes for a successful revision!

Mario Diana, MD
Plano Plastic Surgeon
4.5 out of 5 stars 28 reviews

Implant positioning

Implant positioning after breast augmentation is a topic I spend alot of time on in the office before surgery.  A patients breast shape before surgery is a good indicator of what it will be after.  Breast bone width is just one of the features I discuss.  The direction your breasts point can be due to the rib structure too.  Good support after surgery is very important and I feel not stressed enough to patients.  You are lacking inferior and lateral support and discussing this with your doctor will get you the best result.  Thank you for your question.

Thomas P. McHugh, MD
Houston Plastic Surgeon
3.6 out of 5 stars 22 reviews

Correction is possible

Dear Maryanne, corrdection is certainly possible but does take some work.  On examining you I would want to check the  size of the pocket.  If there is room medially when you push the implants together then you would do one or both of these.  You would close off the lateral pocket and use say a lower profile implant, like a moderate profile plus or style 15.  This should correct the problem, altho if you have weak tissue you may also need something like starttice or alloderm to support the implant.

If the implants don't move medially - towards the sternum but do fall under the armpits you would again need to repair the pocket laterally but also release the pocket medially.  Speak to your surgeon and get a second opinion if it makes you feel more comfortable before proceeding.  Good luck, Dr. Schuster in Boca Raton

Steven Schuster, MD, FACS
Boca Raton Plastic Surgeon
4.0 out of 5 stars 6 reviews

Implants too Far to the Side

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!

Brian K. Reedy, MD
Reading Plastic Surgeon
4.9 out of 5 stars 144 reviews

Implant Malposition

While the views provided are not ideal for the evaluation of your breast, it appears as though the implants are not in the correct position. It appears that the pocket in which the implant sits needs to be corrected by reducing the inferolateral (below and outside) portion of the pocket while most likely having to further release the inferomedial (below and inside) insertion of the Pectoralis Major muscle as well.

I would recommend that you get a second opinion from a Board Certified Plastic Surgeon that can help you feel at ease in their ability to resolve the issue. Thank you for the question and the pictures. Best of luck.

Pedro M. Soler, Jr., MD
Tampa Plastic Surgeon
4.9 out of 5 stars 39 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.