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Wide gap when lying down after breast augmentation. What can be done?

I had a BA 4 months ago (silicone,round,smooth,under,500cc mod profile (5'10,135lbs)). I love the way they look when I stand up, I have maybe a one finger space. But when I lay down they fall to the side and I have an almost 4 finger gap. I already spoke to my doctor and he says its normal, it's just the gel shifting and nothing can be done. But it feels like the whole implant is moving to the sides because the gap is not there when I stand up. I'm seeing another doctor soon but want more opinions.

Doctor Answers 14

September 2nd, 2015

Wide gap when lying down after breast augmentation.

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Hi, Saa1108.  In-person examination will be needed for accurate assessment.  Based on your description, your implant pocket may be too large for your implants.  This may be due to overdissection of the pocket or stretching of the pocket soon after surgery.  Options to correct the pocket would be 1) suture re-inforcement or 2) placing dermal matrix or mesh to make the pocket smaller.  I think getting a second-opinion to be examined in-person is a good idea. 

Learn more: http://www.drkimplasticsurgery.com

Sugene Kim, MD, FACS
October 7th, 2015

Wide gap when lying down after breast augmentation

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To have some separation in the middle of the breast after breast augmentation surgery is normal, but excessive width could be due to pocket expansion. If the pockets have expanded laterally you will need to have a surgical repair known as capsulorraphy where the surgeon will go in using an internal suture to close the pockets laterally, pushing the implants inward to minimize the gap.

Learn more: http://cosmeticplastics.com/

Franklin D. Richards, MD
September 2nd, 2015

Floppy breast implants

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Your description sounds like you have had an over-dissected breast implant pocket during the surgery, although a physical exam is required to know for certain.  I would recommend getting a second opinion from a board certified plastic surgeon.  The most affective means to correct this problem is with a biological mesh, such as Strattice, to form a hammock to push your implants back towards the center of your chest.  I wish you the best with your problem.

Patrick C. Wilson, MD
Huntsville Plastic Surgeon

September 2nd, 2015

Pocket size

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Thank you for your question.  It sounds like from your description that the lateral (outer) pocket may be too large allowing the implant to displace.  This can be corrected by narrowing the pocket down, or by creating a new pocket and being mindful not to oversize it.  Good luck.
Young R. Cho, MD, PhD
September 2nd, 2015

Wide gap when lying down after breast augmentation

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All breasts to the side of bit when lying on one's back. However if the gap between your breasts is too large this can be surgically corrected utilizing sutures that close the outer portion of the implant pocket. A big question is whether this is worth it to you that is should one undergo a surgical procedure with inherent risks to improve this situation. If you are happy with your breasts when you're standing upright, you may wish to thank about all your options. Discuss this with your surgeon regarding risks and possible benefits.
George Volpe, MD
September 2nd, 2015

Gap after breast augmentation

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First, you anatomy dictates your cleavage. If your implants are falling way off to the side, this may be related to many things including, pocket issues and tissue laxity. Hard to say without an exam.

Learn more: https://www.stevenwallachmd.com/breast-procedures/breast-augmentation-new-york/

Steven Wallach, MD
September 2nd, 2015

Gap between breasts after breast augmentation.

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Many women are sensitive about a possible gap between their breasts after breast augmentation surgery. On the other hand, it is normal and natural that the gap should widen when you lay down just as it does with natural breast tissue, thus giving your breasts a more natural appearance. Smooth round implants do move more, as well.


It sounds that the gap that is created when you lay down is too wide for your taste. In order to try to close the gap nonsurgically, I would purchase a bra with extra lateral support that pushes your breasts to make more cleavage and wear it 24 hours per day for 6-8 weeks.I would encourage you to massage the implants inwards (and not outwards) twice daily. This may allow for some shrinking of the outer pocket as you nonsurgically place the implants more medially.

Other options would involve a second surgery and could include;

1. suturing the pocket closed on the outside
2. inserting a reinforcement matrix, which I would describe as a biologic patch, (acellular dermal matrix)
3. Fat graftin, or transfering fat from another area of your body that could be suctioned then inserted into your cleavage area 

The good news is that even if you decide to have secondary surgery, the implants can usually be left in or removed and put back in and the second surgery would just fine-tune your result.

I would recommend waiting 6 months to 1 year before revision surgery to make sure that the healing process is complete and that there's nothing else that you choose to change.

In the mean time, get a few opinions from the excellent Plastic Surgeons in Montreal, my own home town! 

Learn more: http://www.awomanplasticsurgeon.com/breast/about-breast-implant-surgery

Cynthia L. Mizgala, MD
September 2nd, 2015

Wide gap when lying down after breast augmentation. What can be done?

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Thank you for your question, and I am sorry that you are having difficulty with your implants.  Without a photograph, or in-person examination, it is difficult to know exactly what is taking place.  It sounds as if the pocket within which your breast implants are sitting is too large.  This can occur either at the time of surgery with over dissection of the pocket, or over time with larger implants as they can stretch the tissues.  I would recommend you see your plastic surgeon for an examination. They will best be able to make treatment recommendations.  

Learn more: http://www.nelson-center.com/breast-augmentation.html

Nelson Castillo, MD
September 2nd, 2015

Over dissection of the pocket can create implants that fall too far laterally one recumbent.

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From the description it's possible that the pockets are larger than needed for your breast implants. If over dissected laterally gravity will pull the implant out of position when you're in the recumbent position. This is something your plastic surgeon can discuss with you.

Learn more: http://www.zubowicz.com/procedures/breast-augmentation/#2649

Vincent N. Zubowicz, MD
September 2nd, 2015

Breast Augmentation - Implant movement

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This can be common after breast augmentation if the implant is smaller than your implant capsule or pocket. You didn't mention if your augmentation was a primary surgery or a revision of a previous implant? In either case, to correct implant movement requires revising the pocket that the implant is sitting in so that it does not have as much space to shift with your body movement. 

#PlasticSurgery #BreastAug #Implants #Implantmovement #recovery 
Jed H. Horowitz, MD, FACS

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.