My implant width is over 6cm less than my BDW - should I have had wider Breast Implants? (photos)

Good afternoon,
Your surgeon made some terrible choices and gave you a bad result, plain and simple. First of all, you needed a lift. Second of all, in an attempt to avoid a lift they overdissected your pockets and gave you lateral displacement and bottoming out, which further increases your gap and decreases your upper pole fullness. And finally, blaming the gap on your anatomy versus their poor surgical skills is just lame. You need a donut mastopexy, which you always needed, and you need the Original Internal Bra, my strong permanent internal suturing technique which corrects both bottoming out and lateral displacement and will provide excellent cleavage and upper pole fullness. I first developed this technique over 20 years ago, and today it is the most common revision procedure I perform, at least 5-6 times a week- it works and it lasts. Finally, we will switch out your implants for slightly larger High Profile. Your surgeon chose UltraHigh Profile implants- the narrowest implants on the market- you never do that for a patient with a wide gap- what a big dummy!

Dear Calm131873,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

There are many things to consider when selecting an implant including volume, type, style, and projection. Your photos indicate that you would have benefited from a breast lift when you had your augmentation. Selection of a wider implant would not have taken the place of a breast lift which removes excess skin and raises the position of the nipple/areola complex.

You need a lift and no lift was done. Implants cannot make up for the made of a lift. Going wider with implants will not help.

Considering what was done for you, and depending on what your overall goals were going into surgery, your result is reasonable.
Your preoperative photos - I am assuming the first two - demonstrate a significant breast asymmetry with ptosis (drooping) on your Left side (assuming your phone did not flip the image on "selfie" mode).
In my hands, I would not have offered augmentation alone with the discussion of a concomitant versus staged mastopexy (breast lift). A common move - or mistake - that surgeons do (sometimes at the express request of the patient) is to offer breast augmentation with implants alone in the hopes of filling out a sagging breast. This can work for mild (Grade 1) ptosis but not the situation that I see with your Left breast, which arguably shows Grade 2 ptosis on the 3/4 (oblique) view photograph.
You are right that the implants have exacerbated your wide cleavage that was apparent preoperatively. Your surgeon's implant choice was not unreasonable - selecting a very wide implant may have compromised on projection, whereas your surgeon selected a narrower implant which enabled a high profile (projecting) to instead account for the 475cc volume.
The bottoming out on the Left is not unexpected as you had a ptotic Left breast to begin with. The animation deformity is also not unexpected, but I wonder if your implants were placed with complete muscular coverage or instead placed in a Dual Plane fashion (muscle coverage along the upper portion of the breast, and subglandular coverage along the lower portion - the extent of Dual Plane depends on the extent of breast pocket dissection). The more muscle stays intact over the implant along the lower aspect of the breast, i.e., along the inframammary fold, the greater the likelihood you would experience animation deformity postoperatively.
Again, your result is not unreasonable, having undergone breast augmentation alone without a mastopexy. I would live with your current implants before considering an implant exchange and revision mastopexy at a later time in your life. Whatever you ultimately do, stick with a Board-Certified Plastic Surgeon who is familiar with a variety of techniques to address your breast anatomy and current set of implants.