Have my Implants Been Placed too Far Apart? (photo)

hi i had my ba on the 3rd of september 410 cc anatomical dual plane. Im not happy with my cleavage or lack of it when i mentioned this to my ps he said my breasts were far apart before he never mentioned before my surgery that i would have a wide gap and i could get a cleavage after breast feeding anyway my questions are have my implants been placed to far apart and will i eventually be able to push them together many thanks

Doctor Answers 23

Are implants too far apart

The limitation in your situation is that your sternum (breast bone) is wide and your nipple/areolar complexes are already pointing out (lateral).  One solution for improving the result and giving you more cleavage would be to inject fat in the medial (inner) part of your breast.  That would give you more definition where you want it without creating distortion.


Chicago Plastic Surgeon
3.5 out of 5 stars 19 reviews

Placement of implants

you have several anatomic issues.   your areolas point out.   placing the implants closer makes this worse.

your  breast are naturally far apart and divergent..  the result looks very reasonable

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

Breast augmentation -getting it right the first time

Your before picture shows nipples that point outward to the sides. The aesthetic norm is for them to point straight forward. This should have been apparent on your preoperative exam and appropriate measures taken during surgery to correct it. You did not have cleavage before surgery and implants cannot create cleavage. Cleavage does not magically appear after breast augmentation. The before photo is not adequate to fully assess your before surgery condition as it was shot from an upward oblique angle. Your after photo shows the left breast fold is lower than the right and the nipple divergence from the midline as expected is greater after the augmentation. From the limited information in your post it is impossible to know what the breast crease levels were before surgery or how much of your result is due to what you started with vs. the surgical planning and execution.

The take home message is that before undergoing breast augmentation make sure your surgeon does a complete examination with breast measurements (that involves using a ruler) and then goes over the operative plan with you so you have a reasonable idea of what to expect from different surgical modalities that can be employed. In the US we call that process informed consent which is slowly disappearing as patients here increasingly shop breast surgeons for the lowest price.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery. Most of the scar tissue that arises is formed in these areas of tissue plane separation. The same applies to breast implants where most of the scar is really around the implant.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Have my Implants Been Placed too Far Apart?

Your breasts appear to be far apart pre-operatively, and your nipples are VERY laterally placed.  If your implants were closer together, then your nipples would look even MORE laterally displaced, pointing out to your sides.  You appear to have very thin tissue, and therefore need to have your implants placed beneath the pectoralis muscle for better coverage and to prevent post-operative visible wrinkling (as I assume they are). However, you can only release the muscle so far towards the middle before you cut through the whole muscle and it retracts, your implant and implant wrinkling becomes visible through your thin tissues without muscle to hide it, and this is VERY difficult to impossible to correct.  In other words, there is a limit, depending upon your anatomy, as to how close to each other your implant pockets can be made, and ultimately your ribcage shape will also determine where the implants will rest unless they are actively being pushed together by a push-up bra.  Although patients will differ, according to their anatomy, as to how close together their implants will lie, cleavage is only formed as the result of a bra pushing breasts (with or without implants) together.

Implant Placement

When patients have a wide breastbone and/or breast that are positioned more laterally on the chest with lateral nipple position, it is impossible to have the cleavage you seek when you are not wearing a bra.  The implants are centered beneath the nipple/areola complex.  If your try to move them more medially, your breast shape will look funny with too much fullness medially and a flat lateral breast.  As your breast soften, cleavage will be closer with your bra on.  Anatomical chest wall differences have a lot to do with your postoperative shape.  I think that your results are very good for the type of breast and chest shape apparent in your preoperative photos.

Implants

The results of breast augmentation are bit limited by your anatomy. If you have wide cleavage to begin with, it is very hard to create a lot of cleavage.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Implants too far apart?

I don't think they are too far apart. Your breasts were fairly wide apart which would make it very difficult to get well proportioned enlargement and cleavage (out of clothing) at the same time. It looks like your surgeon did a nice job. Your breast look equal and very nicely shaped. More implant towards the cleavage area would make your nipples look pushed even further out to the side. 

Have my Implants Been Placed too Far Apart? (photo)

Thanks for the posted photos. Based on all the experts it is based upon your anatomy primarily. Discuss with your surgeon. 

Breast inplant placement

Thank you for the photos. Most of the time the goal is to have a 2 to 4 cm space between the breasts. A board certified plastic surgeon can make the distance smaller. If too small there is a risk of symmastia. Each patient's chest wall and soft tissue is different. There is an interaction between the chest wall, soft tissue and the implant itself. This can drive the implants apart at times. In your case, you had wideness between the breasts and the areola is laterally placed.  Placement of the implants more medially would accentuate that.  Cleavage comes from bras that push together the upper pole.  It looks like, given your tissues, that you have a very reasonable result.  Make sure you tell al of your concerns to your board certified plastic surgeon. It is okay to ask questions.

Jeffrey J. Roth, MD, FACS
Las Vegas Plastic Surgeon
4.6 out of 5 stars 16 reviews

Space between implants

Your breasts will certainly improve in shape over the next 6 months since you are very early in the post operative recovery process. The distance between the breast is determined by several factors.
This included the anatomy of your chest and sternum. Since the implant, if placed under the muscle, can only go as close to the middle as the edge of your breast bone this is one limiting factor. If the rib cage is flat the breast will project forward, if it is angled they will project to the side. These are all factors that can be discussed with your plastic surgeon.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 16 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.