8 months post breast augmentation- are my breasts malpositioned?

Question

I feel like I have no volume near breast bone, most volume is out towards my armpits. Do they look malpositioned? What can fix this?

Richard J. Restifo, MD · Answer

I think that you look great. There is a limit to how close the implants can be near the breastbone because the tissue there is thin and no one wants to see the edge of the implant in the cleavage area.  Sometimes the implants will have a tendency to fall towards the armpits when a patient is lying flat; that problem can sometimes be corrected by closing off the pocket so that the implants don't go there, but that would require additional surgery and from the photos it does not seem like that issue is a problem.Best Wishes.

Gary M. Horndeski, MD · Answer

In your pre-op photograph, your breasts hang too low and lateral.  Simply adding implants make the problem even more noticeable. The added weight of the implant will make the breasts droop even further and require revision.  The technique I recommend is explanation using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

Donovan Rosas, MD · Answer

Patients must understand the limits of the surgery. Implants will not create cleavage in the sense that they cannot medialize wide or lateral set breasts. The implants will be centered on your native breast mound which may seemingly worsen the wide set nature of the breasts without actually changing the measurements. It is often helpful to think of breast augmentation as a magnifying glass or IMAX screen where all aspects of the breast are enlarged (+) and (-).
One option for creating a more central or medial mound is subglandular augmentation. In this scenario, the medial boundary as defined by the pectoralis muscle attachments to the sternum are not present. This can allow for greater medial dissection and by association greater cleavage (not recommended). However, this does in crease the risk of symmastia. There is also the risk of deformity which stems from failure to center the implant on the native breast mound.
Ultimately, cleavage is essentially a function of the anatomic starting point. If you have wide set breasts, implants are only likely to accentuate this deficit. However, patients with closely spaced breasts will accentuate their cleavage via augmentation. Trying to force the mound centrally often leads to a mismatch between implant and native breast. They must be centered on each other in order to obtain a good result.Based on your photos, you have an excellent result. Your breasts were widely set pre-op and your implants are centered on your native breast mound.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Mathew A. Plant, MD, FRCSC · Answer

Where implants should be placed is determined by your underlying anatomy. These implants are centred perfectly behind your nipples which means they’re definitely not malpositioned. You have naturally wide set apart breasts which will limit how much cleavage you can get without a push-up bra. A lift might help a little bit however there’s only so much that can be changed with surgery.  The only way to know for sure is to book a consultation with the breast revision expert in your area to be examined. Hope that helps!

Thomas Trevisani, MD · Answer

The breast size and shape after Augmentation will be the same but more pronounced after the implants are placed. The best way to change shape and position - is with a mastopexy/ breast lift. The results appear satisfactory but only you can be the final judge.

Don Fontana, MD · Answer

No, your breast implants are in excellent position. The implant must be centered under the nipple and your surgeon has achieved that very nicely.

Paul J. Leahy, MD · Answer

Thanks for your question. I think you have a beautiful result! There is only so much that we can do during this operation to place the implant. It is largely dependent upon the patient's underlying anatomy. You have a natural look which is desirable. I would suggest following up with your surgeon and choose bras/clothing that give you the look you are after. Best wishes

Steven Wallach, MD · Answer

getting more medial fullness is limited by your natural anatomy. A lift may help tighten the skin envelope and give you more of a medial fullness but this will add scars to your breasts.

Evan Sorokin, MD · Answer

The appearance of your breasts is a predictable result given the starting position and shape of your natural tissue.  The only way to move it up and towards the breast bone as you describe would be by doing a lift to reshape the natural tissue.  The downside of the lift is of course the incisions that are involved but otherwise the implant is just giving you a bigger version of where you started.  I hope this helps.  Best of luck!

Kevin Tehrani, MD, FACS · Answer

Thank you for your question, unfortunately it is difficult to tell from the picture, however, based on your description you may need a pocket revision and or implant exchange. You would need a consultation to discuss your options in detail.

8 months post breast augmentation- are my breasts malpositioned?

Answers (13)

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