Can you overcome a large chest gap with a wider implant?

Patients must understand the limits of the surgery. Implants will not create cleavage in the sense that they cannot medialize wide or lateral set breasts. The implants will be centered on your native breast mound which may seemingly worsen the wide set nature of the breasts without actually changing the measurements. It is often helpful to think of breast augmentation as a magnifying glass or IMAX screen where all aspects of the breast are enlarged (+) and (-).
One option for creating a more central or medial mound is subglandular augmentation. In this scenario, the medial boundary as defined by the pectoralis muscle attachments to the sternum are not present. This can allow for greater medial dissection and by association greater cleavage (not recommended). However, this does in crease the risk of symmastia. There is also the risk of deformity which stems from failure to center the implant on the native breast mound.
Ultimately, cleavage is essentially a function of the anatomic starting point. If you have wide set breasts, implants are only likely to accentuate this deficit. However, patients with closely spaced breasts will accentuate their cleavage via augmentation. Trying to force the mound centrally often leads to a mismatch between implant and native breast. They must be centered on each other in order to obtain a good result.With regards to your specific question, when placing the implants submuscular, greater width will not improve cleavage. On the contrary, increasing width and exceeding your specific BWD will lead to a frame mismatch and lateral migration towards the armpit.
As always, discuss your concerns with a board certified plastic surgeon (ABPS). 

Surgeons cannot create cleavage at surgery if you have a large gap. Over dissection to try to create cleavage leads to bad problems like off center implants. However, surgeon can create more volume by adding implants. Once the soft tissues stretch with the implants, then you can create cleavage in clothing with the right bra. Good luck.

Implants of any width cannot build cleavage. The good news is that implants of any width will give you more volume and size, a fact which will make it easier to create cleavage in and with clothes.Dr. Ted Eisenberg, Board Certified Plastic Surgeon and AuthorRealSelf Distinguished Hall of Fame Inductee

Hi eemm19,

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.

Implant profile is one of the important considerations to make. Many patients wrongly assume that the higher the profile the better. The truth is, the more profile (or projection/height) and implant has, the narrower its base has to become. This is associated with several problematic consequences.

The first issue is that the patient loses width and therefore cleavage of the breast. The second is the breast becomes more narrow and pendulous, often falling lateral and onto the side of the chest, and third, high profile implants have a higher risk of bottoming out because they exert more pressure on the inframammary fold than moderate profile implants.

High profile implants do have a role in symmastia repair (when I need to narrow the base width) but otherwise I try to avoid them.

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, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

Breast augmentation does not have a significant effect on the gap between the breasts, often referred to as cleavage. Although wider implants do decrease the gap, it may not be appropriate at all times. Large implants are usually decided by the surgeon based on the chest wall measurements of the patient, the skin elasticity and the desired result. Having too large of an implant may cause the breasts to be too heavy and may cause loose skin. Schedule an appointment with a board certified plastic surgeon for an in person examination and a detailed discussion of your surgical options.

Thank you for the good question.  Based on your question, I think that you have a good understanding already. You are correct in that your anatomic starting point will to some degree determine how much space will be present between your breasts after breast augmentation surgery.  Other factors involved include careful breast implant pocket dissection and careful selection of breast implant size/profile.  Remember (when it comes to breast implant pocket dissection and achievement of ideal breast implant cleavage) that each nipple/areola complex must be centered on each breast mound.
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural result” or "C or D cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this helps. Best wishes for an outcome that you will be very pleased with.