Intermammary distance, implant placement, and shape/profile (Photo)

Question

I recently got my first consultation and it went great until I saw the vectra results. I did the consult following a referral; however, on looking at the gallery many of the results seem to have a wide distance. I did research and found placement, profile, and shape have a lot to do with this. I know the intermammary distance is something that can't be changed, but mine isn't far (2cm) and images show elsewise. Thoughts if I should see a different doctor or change implant?

Natalia Vidal Laureano, MD, FACS · Answer

Hi! Thanks for your question! Like you mentioned intermammary distance is something difficult to change as it may distort the normal attachments of the breast and create symmastia (uni-boob). The problem with trying to fix the intermammary distance with implant placement more medially, is then your nipple position may seem more lateral. In regards to the profile, I recommend a moderate profile implant, therefore is a wider implant that can fill the entire pocket better. I would choose a larger volume implant (probably in the 300cc range to give you a fuller look and more cleavage. Hope this helped!

Finny George, MD · Answer

Hi, thank you for sharing your question. You are a good candidate for breast augmentation. The Vectra images are fairly accurate in predicting your final outcome. While you may find slight differences between the implant characteristics and your final result, the overall position of your implants is determined by the current anatomical restrictions. Your cleavage will be improved and therefore, the inter-mammary distance will be less apparent. I hope this helps n

Irena Karanetz, MD · Answer

Hello,
Thank you for the question.
Based on your photos, you appear to have wide intermammary distance and subglandular (above the muscle) breast augmentation may be a better options for you rather than submuscular (below muscle) in order to achieve full cleavage in the middle.
Implant size discussion and implant selection is one of the most important steps during your consultation with plastic surgeon. The decision-making process depends on patient’s desires, as well as breast and soft tissue dimensions. 
Implant projection varies between low, moderate, moderate plus and high profile within the three major breast implant companies (Sientra, Allergan and Mentor). Patients who desire a more natural look typically go for moderate/moderate plus profile, while patients who desires a more full and augmented look with typically prefer moderate plus/high profile breast implants. 
I would encourage you to seek a consultation with a Board-Certified Plastic Surgeon specializing in Breast Surgeries to further discuss your options, specific techniques, concerns and expectations.
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Ted Eisenberg, DO, FACOS, FAACS · Answer

Can't build cleavage, but the good news is, regardless of placement and shape/profile, you will have more volume or size. This fact will make it easier to create cleavage in clothes. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Ronald J. Edelson, MD · Answer

Your breasts are wide set and your nipples wide apart as well. It will be difficult to get a narrow gap between the implants in your case. Implants tend to center themselves under the loosest skin which in where the nipples are.

Daniel Barrett, MD · Answer

Dear travelingmidwestgirl,
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

Camille Cash, MD · Answer

There's no harm in going to a few board certified plastic surgeons for consultations just to hear different points of view.  From the submitted photos it does appear that your breasts are somewhat wideset and your nipples point more in an outward direction.  Breast augmentation alone will not greatly change this.  It will add more volume but will generally be a larger version of what you currently have.  To change nipple position or give an appearance of more cleavage further interventions would need to be considered.

Michael S. Wong, MD · Answer

Dear travelingmidwestgirl,
Thank you for your question and pictures. The intermammary distance can be narrowed by using a larger base width implant. Remember that the implant is best centered under the nipple, so pushing the implants more toward the center to narrow this distance and ignoring the position of the nipple is a mistake. Imaging having the implant pushed towards the middle with the nipples on the outside of the breast mound created by the implant. This creates an odd look. Thus, much of how much the intermammary distance can be narrowed is constrained by a patient's anatomy. 
Hope you find this helpful.

Connie Hiers, MD, FACS · Answer

You are a little wide which cannot be changed. I would suggest placing the implants behind the muscle to avoid the round ball look and give better coverage and support.

Raul Trujillo, MD · Answer

Hello, thank you for your question. Most women with small breast volume tend to have divergent areolar, or long intermammmary distance. As you said, this can be corrected using implants. You have to see the implant as a dome, and the nipple should fall in the implant most projected point. So, if you have a narrow base implant, the mosto projected point could stand medial to de nipple, making the nipple more divergent. If you use wider base implants, the implant most projected point could fall where your nipple is, not moving it at all. What you should know is that if you want the nipple to move medially, the implant should be placed more laterally in order to displace the nipple to de medial line, but this is not advisable, as a lateral placed implant will have lateral displacement and will leave a broad space between de cleavage lines.

Intermammary distance, implant placement, and shape/profile (Photo)

Answers (11)

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