Which type of breast implant is best for wide set/ splayed breast? And which size to have a natural tear drop shape? (photo)

Question

Im a 32 years old mom of a 4 years old boy. I breastfeeding him for 14 months. I'm wearing a 34 A or B (small) depending on the brand. I have a wide inter-mammary distance breast. I know that if I do the procedure the space is gonna be there, but what is the best to do to do an augmentation and make it closer staying in the D range?

Gary M. Horndeski, MD · Answer

Implants alone will not correct your wide separated
breasts.You will need a simultaneous
lift.I recommend a new technique called
Breast Augmentation with The Horndeski Method&trade;.Using only a circumareola incision it is possible to reshape your breast
tissue creating upper pole fullness, elevate them higher on the chest wall and
more medial to increase your cleavage.Aligning the areola, breast tissue and implant over the bony prominence
of the chest wall maximizes anterior projection with a minimal size
implant.Small round textured silicone
gel implants placed retro-pectoral look and feel more natural, are more stable,
less likely to ripple or have complications needing revision.Implant profile is irrelevant in the
retro-pectoral position since the muscle compresses it.At size 34 each 100 cc’s of implant
corresponds to 1 cup size change.From
this, you can compute the volume required to achieve your desired goal.Best Wishes,Gary Horndeski, M.D.

George John Alexander, MD, FACS · Answer

Thank you for providing a photo.  An in-person consultation will be important
for you to get a better idea of sizing, style and shape of the implant that
will provide the best results for you.  A
board certified plastic surgeon will perform an exam, take measurements and
then be able to show you the styles and shapes of implants recommended for
you.   We also have patients try on implants in our
office to get an idea of what the size will look like with the rest of their
body; as not only breasts change after pregnancy but also hips and
abdomen.  Implants that are designed to
be wider will help fill in the space between your breasts to achieve more
cleavage.  I am able to help achieve the
more natural “tear drop shape” breast by the way I place the round implant in
the breasts and contour the inside of the breast.  The next step for you will be to schedule a
consultation appointment and start gathering the information that is most
appropriate for you.  Our Moms who have
the surgery after breastfeeding are so happy to get their breast fullness back again
and I am sure you will be too.

Robert Singer, MD · Answer

The best cosmetic result in any particular breast
augmentation patient depends on a variety of factors, including: Your
individual anatomy, realistic expectations, a thorough discussion with the
plastic surgeon about the options, and an understanding of the pros and cons of
any particular implant choice. Proper sizing is not just about the number of
cc’s. The thickness of your tissue, breast dimensions which include the width,
height, and projection, as well as chest wall width all need to be considered
when choosing an implant. Trying on implant “sizers” of various shapes and
volumes while wearing a tight t-shirt, bra, or bathing sit at a preoperative
visit will help you and your surgeon choose the optimal implant.

There are no manufacturers' standards for cup sizing in the bra industry. The
cups of a 34 D and a 38 D are significantly different. Cup size varies from
manufacturer to manufacturer and even within styles from any particular
manufacturer.

Keep in mind that following the advice from a surgeon on this or any other
website who proposes to tell you exactly what to do without examining you,
physically feeling the tissue, assessing your desired outcome, taking a full
medical history, and discussing the pros and cons of each operative procedure
would not be in your best interest. I would suggest you find a plastic surgeon
certified by the American Board of Plastic Surgery and ideally a member of the
American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are
comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Joseph L. Grzeskiewicz, MD, FACS · Answer

It will be difficult to provide any lady with specific recommendations for surgery in this format, as that would require an in-depth consultation including a thorough exam of your breasts to evaluate your specific goals and how best to arrive at them.  However, I can offer some general considerations that may take your specific case into account.  The first, and probably most important thing to note here, since we are talking about spacing, is that no matter what, THE NIPPLE MUST REMAIN THE VISUAL CENTER OF THE BREAST. . . after surgery.  If we try to force the issue and place the implants closer to the middle to reduce space, we will wind up with nipples off-center that point laterally, and that looks weird.  Similarly, if we place the implants too high or low, the nipples will point in the opposite direction and either point too low, or too high respectively.  This is especially true when we consider anatomically shaped implants.  These implants are textured, so they won't move or "settle" much, if at all, after surgery, and they are designed specifically to be placed extremely accurately at the time of surgery with the proportions and placement that I outlined above.  Having said that, I put in a LOT of shaped implants, and I love them, especially for ladies such as yourself who have smaller volume tissues and who want a more natural appearance.  Even if the intermammary distance is slightly wide, and we are beholden to that by naturally wide nipple placement as I outlined above, if it is done right, the medial aspect of the breast can be made to have a very soft and natural contour, and it will still look very beautiful.  Inherent in this is the selection of the right type, volume, and dimension of implants, and that is why it is very important for you to consider consultations only with experienced board certified plastic surgeons who can properly evaluate you for all available options and then provide the option that suits you and your needs the best.  I would definitely consider shaped implants in your case, based upon the image you have shown, and if you find a surgeon who will offer this as an option and with whom you are comfortable, I would certainly advise you to consider it based upon my own experience with those implants.  Good luck.

Tom J. Pousti, MD · Answer

Thank you for the question and picture.  
 Unfortunately, online consultants will not be able to provide you with specific enough advice to be truly helpful.  Ultimately, careful measurements (dimensional planning) and careful communication of your goals will be key.
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery (regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals  with your plastic surgeon. This communication will be critical in determining  breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as  “natural” or "C or D cup" or  etc means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery ( after the use of temporary intraoperative sizers).
I hope this, and the attached link (dedicated to breast augmentation surgery concerns), helps.

Ronald V. DeMars, MD (Retired) · Answer

The fina result of a breast augmentation is usually a reflection of the preop anatomy. Patients that have a "wide space" between the breasts have no breast tissue on the area and usually have wide set pectoralis muscles so they are always going to have a wide space after surgery also, since there is no way to place the implants close together and have adequate soft tissue coverage over them.

Vincent D. Lepore, MD (retired) · Answer

I think Dr. Pousti has given you good advice, the questions you have asked will probably be best answered by  the surgeon who examines you.  I would just counsel you, that from your photo, you appear petite and choosing an implant in the D cup size range will probably not result in a natural tear drop shape.  Also, ask your surgeon if a breast lift might help address the wide inter-mammary distance.  Best wishes, Dr. Lepore.

Which type of breast implant is best for wide set/ splayed breast? And which size to have a natural tear drop shape? (photo)

Answers (7)

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