Are my implants too far apart? Is it possible to have them placed closer together? (photos)

I'm 5'3, 129lbs, 30 yrs old. I had my augmentation done exactly a year ago. Under the muscle, 450cc, silicon implants. I was pretty flat to begin with. I asked my surgeon for a natural looking size (a size that fit my body). My implants feel like they're always to the sides of my chest. When I lie down they go all the way out to the side. I feel like my chest is still flat and my implants are located on the side. I can't get cleavage from a bra. Would they loon better on top of the muscle?

Doctor Answers 8

Implants too Far Apart?

Thank you for including your before pictures. It is very helpful in analyzing what is going on with your implants now. Your before picture clearly shows that you have a relatively wide space between your breasts and that your breasts start out in a much more lateral location on your chest wall. This has significant implications for how your surgery is performed and on the outcome. It is important that you are made aware of this before your surgery.

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

It is possible to move your implants closer together. To do this, a breast revision can make the pocket smaller on the sides (capsulorraphy) to help prevent them falling to the side. See the below link for details

Breast Implants Appear Too Far Apart

Thank you for the photos and your questions. The pre-op photo shows that your sternum (breast bone) is quite wide and this is the major factor that determines how far apart the breast implants are. Releasing the attachments of the chest muscles to the breast bone can result in synmastia where the implant pockets are no longer separated. Placing the implants above the muscles could also result in this problem as the tissue separating the pockets could thin out. Synmastia can be a challenge to correct. I would consider fat grafts to the inner aspects of the breasts to produce more cleavage with a bra. Ask your surgeon about this option or get a second opinion from another board certified plastic surgeon. Hope you get the result you are looking for!

David S. Motoki, MD
Draper Plastic Surgeon
5.0 out of 5 stars 16 reviews

Cleavage

This is a good question.  Basically the width of your breast bone ultimately dictates the cleavage. Your implants are in the anatomically normal position.  The cleavage can be modified in another surgery, but this would require adding a tissue implant such as Strattice or BellaDerm to support the widening the width of your breast implant pocket.  The tissue implant allows more release of your muscle.  The tissue implant adds support and coverage over the implant, to limit seeing the wrinkling of the implant.
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.

David M. Creech, MD
Chandler Plastic Surgeon
5.0 out of 5 stars 7 reviews

Are my implants too far apart? Is it possible to have them placed closer together?

As I look at your before pictures I see that your breasts were somewhat droopy, very empty with a naturally wide cleavage and a wide positioning of your nipples. I would be reluctant to place an even larger implant and attempts at pushing the implant more toward the midline will result in your nipple being in an awkwardly outward and outward facing position. Any larger implant in my opinion would necessitate a limited mastopexy to raise your nipple position as well. These are all options for you but you need to be aware of the realities of what can and cannot be achieved by having a face-to-face discussion with a board-certified plastic surgeon.


Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Is it possible to have breast implants placed closer together?

Thank you for the question and pictures. Although some “falling to these sides” of breast implants is quite normal when you lie down, if this occurs “excessively”, it may be a concern to patients. This phenomenon is called lateral displacement of the breast implant; it may be of concern from the visual and the discomfort standpoints. Surgical correction is an option.

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

Good evening!

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!

Wide sternum

From your photographs preoperatively it appears to me that you had a very wide space between your breasts from a large breastbone. Your physician has done a wonderful job of centering the implants on the nipples and narrowing that space. If your implants are falling into your underarm when you lie down, then some suturing called a capsulorraphy on the sides may hold them more inward in the line down position. The only way to narrow that space, is now place a wider based implant. With under the muscle location, as you cut more muscle to allow the implant to migrate inward, you risk exposure of potential wrinkles in that location and negate one of the advantages of the sub muscular placement. Be mindful of the fact that if you switch these implants to the sub glandular space, and move them towards each other without making the base wider, then the implant will not be centered on the nipple and the nipples will appear to face outward on both sides. I would discuss these different options with your chosen plastic surgeon. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 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.