Are my implants too far apart? Is it possible to have them placed closer together? (photos)
Doctor Answers 8
Implants too Far Apart?
Implants look best, and are appropriately positioned, when they are centered behind your nipple, as yours are in the upright position. So your surgeon did a good job in terms of getting the implant in the right position. The problem however is that because your breast starts in a more lateral position the pocket gets dissected more lateral on your chest wall and the implant is positioned more lateral behind your nipple. The space between your breasts is improved, although usually not as narrow as you would have preferred. If the surgeon tries to place the implant more towards the middle of your chest it will look weird because it will cause your nipples to rotate outwards and that is not a good look.
The problem for you, unfortunately, is that when the implant is placed more lateral over the downward sloping part of your chest wall, the mechanical and gravitational forces acting on the implant will push it out to the side or into your armpit over time. This particularly true for saline implants, for larger implants, and for smooth surface implants. I am guessing that you have a smooth surface implant because that is what many surgeons routinely use, and this type of outcome is completely predictable.
So how can this be prevented, and what can you do now to fix it? In a situation where a person's anatomy is like yours, this problem can most often be avoided by using a textured surface silicone gel implant. Textured implants allow for tissue ingrowth into the surface of the implant and they therefore "adhere" to your tissues. Because of this adherence, the implants will be much more likely to stay in place and resist sliding out to the side over time. Some surgeons do not like to use textured implants because they feel that they implant does not slide around easily on the chest wall and therefore is less "natural". What exactly is "natural' can be debated, but you implants clearly do slide around easily and you are obviously unhappy with the result.
The texturing is different on each manufacturers implants and Mentor implants in particular have a minimal texturing which will typically not provide enough adherence to prevent this problem.
So how to fix it now? The simplest strategy is to go back in suture the internal breast capsule to the chest wall to tighten the pocket laterally. This is known as an internal capsulorraphy or could also be described as an internal bra. It is generally effective for smaller implants but frequently fails over time with implants over 350 CC. You could reinforce the lateral tissues with an implantable material like Strattice. This makes for a more reliable repair but the materials are expensive and placing them takes more time thus increasing cost. If you wished to use a textured implant, in addition to suturing the lateral implant pocket would would also need to have at least a partial capsulectomy so that the new implant could experience the tissue ingrowth that is necessary for adherence. I find that Sientra implants work best for this type of repair. Using a wider or lower profile implant may also be helpful in reducing the wider space between your breasts.
Correction of Breast Too far apart
Breast Implants Appear Too Far Apart
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Putting the implants on top of your muscle is not a good choice because with minimal breast and thin patients the implant wrinkling is very easily seen. Under the muscle is the preferred location, for your body type, thus allowing your muscle to cover the upper part of your implants.
Are my implants too far apart? Is it possible to have them placed closer together?
Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
Beverly Hills, California
Is it possible to have breast implants placed closer together?
Generally, the lateral breast implant displacement can be corrected using an internal suture technique, decreasing the size of the pockets and moving the implants toward the midline. In my practice, I use a 2 layered suture technique to close off the space laterally (towards the axilla). The use of acellular dermal matrix is an option ( although not usually necessary) especially if significant implant rippling/palpability is present. Also, the use of a larger/wider breast implant may help improve/decrease the space between the breast implants.
I hope this, and the attached link (dedicated to revisionary breast surgery concerns), helps. Best wishes.
Lateral Displacement / Wide Gap / Internal Bra Repair
Your surgeon did a good job, but there is room for improvement. You still have a wide gap, and what you are describing when you lay down is called lateral displacement.
The correct repair is the Internal Bra, my strong permanent internal suturing technique which corrects your lateral displacement. This is the most common type of revision I perform, 5-6 times a week- it works and it lasts!
I would also switch you out for slightly wider implants to fill the gap to give you one finger cleavage!
I have attached a link to my Internal Bra / Breast Augmentation Revision photo gallery for your review- hope it helps!
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.