Lack of cleavage and inner fullness - could a revision fix this? (Photos)

Question

I had 350cc high profile Mentor implants placed over the muscle. I have a naturally wide-set chest (first photo), and my surgeon told me he couldn’t bring the implants closer together because of this. He also said my breast pocket could only accommodate 350cc max. For context, I am 5’8 (172.72 cm) and 135 lbs (61 kg) and 29 years old. My concern is that nearly all of the volume has settled laterally (outward/down toward my underarms) with very little inner fullness. From the front and 3/4 view, the cleavage area looks very flat. I communicated clearly before surgery that I wanted a natural teardrop shape with fullness at the bottom and good inner fullness. I understand my wide-set anatomy means I’ll never have the breasts close together, and I wasn’t expecting that (I don’t mind having a natural gap), but the lack of any inner fullness feels like more than just an anatomy limitation. Am I wrong? Is there anything I could do in a revision to fix this?

Gary M. Horndeski, MD · Answer

I recommend explantation and lift using the Bellesoma. 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 (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. I have been in practice for over 30 years and revision breast surgery is a large portion of my practice.  In your case, you definitely have wide space breast anatomy and your areolas fall to the side.  In your case I would perform an internal bra to bring your implants higher into the center and also you will need to reposition your areolas more to the center.  The more volume you put in the center pushes your areolas out to the side.  You just have a very difficult anatomy.  I have dealt with this many times in my career.  You should be able to have an excellent result.

Jacob Carlson, MD · Answer

Thank you very much for including all of the pictures and details about your procedure. Based on your pre-operative picture, I agree that you have naturally wide-set breasts. The medial portion of the inframammary fold of the breast starts almost the level of the mid-clavicle. Since the implants were placed on top of the muscle, as the descended down into position, they followed your natural anatomy. the inframammary fold is created by a fusion of fascia and collagen fibers, which help the fold maintain it shape and thus give the lower portion of the breast its shape. There's not a great way to disrupt those fibers, allow the implant to fall below the natural inframammary fold, and reliably scar into an aesthetically-ideal shape. Unfortunately, quite the opposite happens - disrupting the natural inframammary fold allows the implant to drop further than it should, resulting in a condition called "bottoming out."
One option to get the implants closer together would be to move the implants to the submuscular position. By doing so, the lateral border of the pectoralis muscle can be used to support the implant closer to the center of the chest, rather than allowing it to follow the natural anatomy of the inframammary fold. If you were to do that though, I would anticipate that a mastopexy (breast lift) would also be necessary. That would allow the surgeon to raise the position of the areola and remove the excess skin from the lower pole of the breast to create a round shape starting closer to the center of the chest. If you were to that and use an implant that has less cohesivity (e.g. Motiva's Ergonomix implants, Mentor's Memory Gel implant, Allergan's Responsive implant), you can achieve a "natural teardrop shape with fullness at the bottom and good inner fullness."

Darryl J. Blinski, MD · Answer

Based on the great posted before &  after photos, your anatomy precludes your desires. I find your surgeon did a very nice implantation and additional survey is not indicated.

Lack of cleavage and inner fullness - could a revision fix this? (Photos)

Answers (4)

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