How Do You Make Sure You Don't Get a Huge Gap in a Breast Augmentation & Why Does That Happen? (photo)

How do you make sure you don't wind up with that huge gap between your breasts from a breast augmentation? How and why does that happen anyways? What are things you can ask or say to make sure it doesn't happen to you?

Doctor Answers 16

Position of Breast Implants

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In many breast augmentation patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola. Ideally the implant should be centered directly behind the nipple-areola complex (NAC). In profile, the natural-appearing breast is not convex in the upper pole, and an excessively convex and overly full upper pole is a dead giveaway that a breast implant sits below the skin. In addition, inadequate release of the inferior origin of the pectoralis major will allow the muscle to hold the implant in too high a position, and may even cause the implant to displace upwards (as high as the collar bone in some patients) when the muscle contracts. Patients with this problem require reoperation to release the inferior origin of the pec major and/or the inframammary fold.

Likewise, if the inframammary fold is lowered too far, the augmented breast will appear 'bottomed out', with an excessively full lower pole, an empty upper pole, and a nipple/areola that appears to sit too high on the breast - another situation with a distinctly unnatural appearance, and one that requires surgical correction: repair of the inframammary fold(s).

The horizontal position of breast implants also requires a great deal of attention, both in pre-operative planning and in the operating room. Excessive lateral dissection of the implant pockets will result in augmented breasts with an excessively wide space between them in the cleavage area, and the appearance that the breasts are abnormally far apart. The result may (or may not) be tolerable in the upright standing or sitting position, but when the patient lays down in supine position (on one's back) the implants may fall far to the side and produce little to no anterior breast projection in this position. Patients with the problem almost always want it corrected, and the treatment once again is surgical: a lateral repair of the implant space, to restrain the implants from falling off to the side.

Inadequate lateral dissection, on the other hand, will result in an augmentation with an abnormal 'side by side' appearance. It is lateral projection of the breasts beyond the lateral border of the chest wall (in frontal view) that, along with the concavity of the waist profile and the convexity of the hip profile, produces the appearance of an 'hourglass figure'. While one does not want to over dissect the lateral extent of an implant pocket, careful attention must also be paid to ensure that lateral breast projection is not inadequate.

Breast implant base diameter is also of crucial importance. The base diameter (the side-to-side dimension of the implant) must be ideal for the existing horizontal dimension of the breasts preoperatively, as well as the breadth of the anterior chest in general. Obviously, a given implant volume and base diameter that works well for a small-framed patient that is 5'3" will be completely inadequate for a broad-chested patient who is 5'10". One wants to increase cleavage area fullness and lateral breast projection in most cases, and an implant of inadequate base diameter may accomplish only one of those goals, while too wide an implant will be overprojecting in both directions. Careful evaluation of all of these breast and implant dimension issues is necessary if the ultimate goal of the surgery is a natural-appearing breast augmentation.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Gap after breast augmentation!

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The gap between the breasts is already there, and by that I mean that this is a natural anatomic landmark. Now, the gap has a large spectrum of variablility between patients. That ranges from almost touching to a seemingly large gap. What the patient starts with in terms of anatomy and asymmetry can be addressed by your surgeon during the augmentation. Therefore, when you seek the advise of a board certified plastic surgeon, he or she will make sure that they point out the anatomy to you and set your expectations realistically, and discuss potential solutions for the gap. This will avoid future disappointments. The implants have to be centered under the nipple. The nipple has to end up at the most projecting part of the breast. Otherwise, the human eye will see it as odd, and out of place. Also, remember that it is not unusual to have differences between the breasts on the same patient, and adjustments can be made in surgery to help even out the over all balance. Since most implants are placed under the muscle that influences the appearance of the gap. The inner border of the implant pocket is the pectoralis muscle. Most surgeon will not cut that part of the muscle. The reason is to avoid a connection between the two breast pockets. The cleavage can be enhanced by choosing a wide enough implant to fit the width of the breast. Other potential causes of wide cleavage is choosing an implant that is two narrow for the breast width or making a pocket that is too wide for the choosen implant.

Prevention of large gap between breasts.

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Thank you for the photo. Most of the time the goal is to have a 2 to 4 cm space between the breasts. A board certified plastic surgeon can make the distance smaller. If too small there is a risk of symmastia. Each patient's chest wall and soft tissue is different. There is an interaction between the chest wall, soft tissue and the implant itself.  This can drive the implants apart at times.  Make sure you tell al of your concerns to your board certified plastic surgeon. Bring in more photos if you can. Together you will make a plan that is right for you.                

Jeffrey J. Roth, MD, FACS
Las Vegas Plastic Surgeon
4.6 out of 5 stars 17 reviews

Gap in a Breast Augmentation & Why Does That Happen?

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There is a great deal of variability i the position of the breasts in women and as a rule, we cannot move the breast to somewhere it has never been. 

Implants are centered on a women's nipple/areolar complex. If they are close together, the implanted breasts will be close together. If they are far apart, the breasts will remain further apart. If a surgeon tries to centralize an implant in a patient whose breasts are further apart, the appearance is downright bizarre. 

Most surgeons in the US when balancing risks and benefits favor placing implants under the pectoralis muscles. These muscles insert into the sternum (breastbone) up to an inch from the midline, and that also serves to limit  the placement of the implants. Sometimes you can get above the muscle implants closer to the center, but there are tradeoffs for that decision.

You seem ready for an in person consultation. RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S.

Your questions can be better answered by a surgeon who is able to do an examination, and can discuss your goals.

Thank your for your question, best wishes.


Jourdan Gottlieb, MD
Seattle Plastic Surgeon


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Your breasts will certainly improve in shape over the next 6 months since you are very early in the post operative recovery process. The distance between the breast is determined by several factors.
This included the anatomy of your chest and sternum. Since the implant, if placed under the muscle, can only go as close to the middle as the edge of your breast bone this is one limiting factor. If the rib cage is flat the breast will project forward, if it is angled they will project to the side. These are all factors that can be discussed with your plastic surgeon.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Adjust cleavage with Mini Ultimate Breast Lift

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Breast tissue detemines the natural gap.  If you undergo breast augmentation only, the implant is centered underneath the areola and the gap may not be reduced.  However, if you undergo a new technique called Breast Augmentation with Mini Ultimate Breast Lift, the position of the breast and areola can be changes.  It is possible to lift your breasts higher to create upper pole fullness and shift your breast medial to increase cleavage.  The areolas are centered over the breast.  The value of this technique is it allows you to align the areola, breast tissue and implant all in the same horizontal plane to increase projection with minimal implant size.  It is possible to adjust your cleavage to your desired goal using this technique.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Preventing the breast gap after augmentation

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The photo you sent tells quite a bit, the round stuck on look with fixed gap between the breasts. The breast implants must be centered under the nipple and the breast and implant should move and flow together. The gap can appear when the breast tissue is thin, the breast widely spaced, and the implant size or profile are too great to blend well with the available breast tissue.The picture screams breast implants, and if you don't like the look make sure your surgeon knows and will guide you to a more natural result.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Gap Between Breasts

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This largely depends on the position of your breasts pre-operatively.  Some women have breasts that sit quite far apart from each other, whereas other women have breasts that are much closer to the midline. 

During an augmentation, the implants are placed so that they are centred under a woman's nipple.  Wherever your nipples are, is where the implant will be placed.

Of course, there are cases where surgical misadventure can cause widely spaced breasts.  If the pocket is dissected to far out laterally, then the implants can migrate laterally.

I suggest seeing an experienced plastic surgeon that is board certified to discuss your surgical goals and expectations.

Warmest Regards,

Asif Pirani, MD, FRCS(C)

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 35 reviews

Breast implant selection and cleavage

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Post-operative cleavage will always be determined by the natural distance that exists between the inner edges of a woman's breasts and the distance between her nipples. When performing breast augmentation, although the implants can be cheated closer together a small amount, they still must be centered more or less beneath the nipples. Placing them elsewhere will lead to an unnatural appearance. This means that patients will have cleavage similar to their natural state even after their augmentation results become visible. Choosing the right implants for you can also help with achieving a more natural looking result, and not the kind you see in the photo you've attached.

How to minimize the gap between breast after implant surgery?

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The implants in the photo represents implants that are encapsulated, too large for her body and are placed too high. Actually, the gap between the breast is less obvious than the encapsulation, which makes them look like half of a ball was stuck on tothe chest.

When a patient is thin, as in this patient, the implant size must be more conservative to avoid this appearance. Oddly, some patients request this look, but personally, I prefer the natural appearance. However, the patient must indicate what they are looking for to the PS, because the goal must be to satisfy the patient.

Implants placed behind the muscle (submusclular) tend to have a wider gap because ot the insertion of the muscle into the rib cage near the sternum. Some of the fibers of the pectoralis muscle must be cut, but some remain attached. Still, when a patient is thin and has very little breast, the submusclular position helps to hide the borders of the implant, which is desirable.

Remember that implants enlarge the existing breast. If the breasts have a wide gap between them, then the gap will still persist even with implants. They simply enlarge what you already have.

Regarding the position of the implants, the implant must be directly behind the nipple, If the implants is placed too high, the nipple will point downward. If they are placed too low, the nipples will point upwards. Your anatomy dictates where the implants must be placed.

Be sure to discuss this all with your PS so you fully understand what to expect and your limitations. Tell him/her what you want and listen carefully to your options, particularly if you want your breasts to look natural.

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.