What causes a large gap between breasts after having had a breast augmentation? (Photo)

Thank you for your question.Your question is a very common one, as many women are interested in obtaining a certain degree of cleavage with a breast augmentation procedure.  The primary reason as to why a patient would have a gap between their breasts post-operatively would be because they had a reasonable amount of space between their breasts pre-operatively.  When performing a breast augmentation, we create the breast pocket and place our implants using the patients nipple as the center point.  Using this anatomical guideline, patients who have wider set breasts will retain this wider set quality even after the implants are placed.  It is not wise or advised for surgeons to use any other anatomical landmark when creating the breast pocket and placing implants as doing so would create an artificial and anatomically poor result (too lateralized or too medial nipples).For patients with wide set breasts, it is possible that a lower profile implant (one that is wider with less projection) may be indicated.  If you have already chosen a board certified plastic surgeon, I would encourage you to discuss your concerns, your anatomy, and what you can realistically expect from a breast augmentation with your surgeon directly.  If you have not chosen a board certified plastic surgeon, please consider scheduling a consultation to discuss the options available to you and your candidacy for the procedure.  In my office, I offer complementary 3D imaging using the vectra system to help patients get a better idea as to how various implants would look on them.  This is something that I believe you might find helpful.  I hope that you find this helpful and I wish you all of the best!

Dr Johnson said it perfectly that the center of the implant goes behind the center of your nipple. This tells us that your nipple were wider and if your doc tried to close the gap then the implant would also be also way out on your side! Perfection is hard to obtain, although I try to achieve it every day!

Thank you for your question. It is generally not the augmentation, but the patient's genetic make-up that causes a large or small gap. Measurements should be taken by the plastic surgeon to determine the implant profile for the patient's desired volume. If you currently have a "2 finger" gap now, this will likely be unchanged. Best of luck!

There are several factors that contribute to breasts that have a substantial gap between them. By far the most common and most important is your chest and breast anatomy. Women with wide breast bones (sternum width) will have breasts that sit farther apart no matter whether the implant is subpectoral or subglandular. Second, some women have ribcages that slant at an angle from the breast bone towards the lateral chest. This will cause the breasts to sit more laterally on the chest. These women also tend to have nipples that point more to the sides. Normally, the surgeon will center the implant on the breast meaning that these women will have implants that sit farther apart. If the surgeon tries to put the implant more medially to improve the cleavage, this will cause the nipple to look like it is off to the outside of the breast mound. Lastly, capsular contracture can tighten the breast pockets and not allow the implants to move medially. This is more common with subglandular placement of breast implants. 

Thank you for your question and pictures.There are many reasons:1. if under your muscles, then your implant placement is limited to your muscle anatomy2. putting implants super close to each other can lead to symmastia (I explain this to my patients as the "uni-brow" of the breasts where the skin lifts in the middle and there is less or no more cleavage)3. Your surgeon may have rightly centered your implants under your nipples4. Gravity will always bring your breasts inferiorly and outwards... law of gravity.  And worse so when not wearing a bra (as it seems to be the case on your very elegant picture).Solutions:1. going larger2. if under the muscle, one might consider going sub-fascial/sub-glandular but one has to be careful for symmastia.2. fat grafting to the inner part of the two breasts is a great option to enhance the cleavageHope this helps!Kind regards,Dr. Marc DuPere

Hello!If your implants are under the chest (Pec) muscle, the wide cleavage may be related to your muscle anatomy and the way the muscle inserts into your sternal bone. If you don't like the way the implants look, you may need to have the implants moved under the breast gland, over the muscle. Or get fat transfer centrally on the breasts to bring them closer together. You should consult with your plastic surgeon about this and see what she/he says. Best of luck!

Dear Cvaz5,I get this problem all of the time.  Typically, its from women who went with high profile implants.  This is a problem because while they project more, they are narrow at the base and can have widening effect on cleavage.  The second most common problem is incomplete release of the pectoralis muscle medially. Many surgeons don't take the time to make this right.  Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Although I have seen a few breast augmentations for revision in which the space could be made smaller, the overwhelming majority are the result of preoperative anatomy.Kenneth Hughes, MD, Board Certified Plastic SurgeryLos Angeles, CA

Good afternoon!I typically aim for a one finger gap unless a patient tells me otherwise.  The key comes down to taking careful chest measurements, particularly your BWD of your breasts and the width of your sternum (breastbone). Then we review photos and try on sizers to figure out how many cc's you need to achieve the size and look you want. Lastly, by knowing how many cc's you need, and knowing your chest measurements, it becomes very simple to figure out the correct profile implant to use. I perform lots and lots of revisions, and one of the most common complaints I am asked to address is a wide gap- sometimes this is from an error in implant selection, sometimes it is an error in overdissecting the sides of the breasts (lateral displacement), and sometimes it results from underdissection near the midline/cleavage area. An intelligent, educated implant selection plus careful, precise surgical technique should allow any patient to avoid an overly wide gap and achieve a nice result.I have attached a link to my Breast Augmentation photo gallery for your review- hope it helps!

The number one reason for a wide breast gap after breast augmentation is the original chest shape. So do indeed have a wider chest and nipple to nipple distance, and for augmentation to look best the implant should be centered under the nipple. For those with a wider chest we often see better cleavage with a lower profile implant.