Did my Surgeon Perform a Poor Breast Augmentation? (photo)

I feel that the gap between my breasts is too wide and that there's not enough cleavage. I've worn Victoria's Secret push-up bras with padding that claim to add 2 cup sizes, but my boobs still don't touch. I have 325 CC round high profile silicone implants under the pectoralis major muscles. Do you think moderate plus profile implants and/or more CC's would lessen the space between my boobs? Did my surgeon perform a poor breast augmentation?

Doctor Answers 13


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One of the first thing I tell patients is that there is no breast tissue in the cleavage area in woman and that you need an implant that is too large for the frame to fill that area and that the only safe long term way to get cleavage is to use a push up bra

Your breast implants look good after your breast augmentation.

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Thank you for your question and photograph. When implants are placed under the muscle, the action of the muscle does tend to push the implants apart. See your plastic surgeon and ask if breast implant displacement exercises might help soften the implants and move and closer together.

The surgeon is not free to place breast implants anywhere on the chest wall.

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Breast implants are placed directly behind the breast. If the breasts are separated by wide sternum that will persist after the operation.

Did my surgeon perform a poor breast augmentation

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It's difficult to say without pre-op photos.  From the photo you provided, you look petite so a moderate implant may have been too wide to use.  Your anatomy will help determine how much cleavage you achieve after your surgery.  The implants should be placed behind your nipples so they are  centered on your breast mound.  If they are placed too medially to attempt to create cleavage, your nipples may point outward.  Best thing to do would be to discuss your concerns with your surgeon.  ac

Angela Champion, MD
Newport Beach Plastic Surgeon

Breast augmentation and anatomy

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In some ways your cleavage is limited by your underlying anatomy and where your muscles insert into the chest. This can limit the cleavage that you can obtain.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

"Poor" breast augmentation?

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There are only two things that I can offer based upon what you have provided here:  first, with the bustier top that you are wearing in the picture, it is impossible to make any clear assessment of the shape or position of your breasts, and second, there are some girls who simply lack enough breast tissue or fatty coverage over the implants to produce a soft contour of the breasts or a close, full cleavage, no matter what sized implants you use or how close you place the implants.  In fact, sometimes this looks even worse with larger implants or higher profile implants because you see the profile and rounder shape of the implants more.  Additionally and ironically(because wearing these articles is precisely why many women get breast implants in the first place), this may also look worse in bustier tops and push up bras, because those articles of clothing will exert their force on the breast as a whole.  In the case of a natural breast, the tissues are pliable and move fluidly and smoothly without creating distinct edges and contours; in the case of an implanted breast without much camouflaging tissue coverage, it will be the implant that is moved primarily, and this will be moved as a single unit.  Thus, the entire breast mound will be pushed upward and/or inward with very distinct contours of the implant visible, unlike the natural breast.  This is one of the most commonly misunderstood things about breast augmentation that I see, both on the part of patients and on the part of surgeons who persist in thinking that if they only put in a larger or wider implant the cleavage would be better.  Many times it is not the surgeon's technique or the implants selected, rather it is the fact that the ultimate shape and position of the breasts depend as much on the native breast tissue as they do on the implants and how they are put in.  If you don't have any breast tissue or fatty thickness approximating your sternum or cleavage before surgery, you certainly won't afterward, and often trying to force the issue with larger or closer implants makes things look worse.  In fact, these are often the times that fat transfer might be indicated to restore some camouflaging soft tissue thickness over the implants to produce a more natural and fuller cleavage.  Of course, the patients in these cases need to have enough of their own fat somewhere else on their bodies, like abdomen, flanks, or thighs, to be able to transfer to the breasts to get the desired results.  This would be the only way to possibly add tissue thickness to the cleavage and eliminate that spacing and obvious breast implant contour.  These are general comments which apply to anyone, and not specifically to you, because, frankly, it is impossible to make any specific comments about your breasts here in this forum.  The best thing to do is to discuss your concerns openly with your surgeon and get his or her opinion on the matter, and what, if anything, can be offered to address your concerns.  Good luck.

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon

The cleavage is the goal

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You look great and I think your surgeon did just fine.   If more cleavage is possible it would be with moderate profile larger implants and with extended medial dissection.  This can however produce a slight ripple effect for some patients when thy lean over.  It would be great to see your before breast photos.  I feel  your surgeon did perfect.  But if more cleavage is the goal, the above stated plan would do it.   My Best,  Dr C

Wide separation between the breasts after breast augmentation.

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Thanks for the question.  When I consult with a patient I try to show the prospective patient why anatomy has so much to do  with the possibility for implants to give a closeness and deep cleavage between the breasts or not.  A narrow sternum will allow the implants to  lie close to one another and favor a nice cleavage between the breasts.  When the sternum is wide and implants are placed  subpectorally, there will be a wide separation between the breasts and nothing will alter this.  Larger implants will not have any effect on this.  The only way to narrow the distance is to place the implants submammary.  Most importantly, don't blame the separation on the Plastic Surgeon!  If you don't like the wide distance, allow the Plastic Surgeon to help you gain a different look for the future, but you have to accept the challenges with having the implants on top of the muscle rather than subpectorally.

Good luck.

Frank Rieger M.D.  Tampa Plastic Surgeon

Cleavage and breast implants

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You can not get the implants, when placed behind the muscle, any closer to the midline than the edge of your breast bone or sternum.  The muscle originates along this margin.  If you try to get more cleavage by dividing the muscle further up the sternum you run the risk of having an abnormal shape instead of more cleavage.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Breast Augmentation Limitations

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This is a very common issue woman have after breast augmentation, and it is one that is, most of the time, inevitable for those particular patients.  The width of your breast after breast augmentation is not just related to the width of your implant, it is more about the width of the pocket created for the implant to sit in. The inner (medial) limits of the pockets are strictly defined by the attachment of the pectoralis muscle to the sternum, which should not be completely violated without serious visible complications.

Unfortunately, in many thin and small breasted women, there is a wide gap of skin overlying the sternum that has no fat or breast tissue interposed, so after breast augmentation, there is a wide 'breast free' gap.  

In regards to you, there might be some margin of improvement in dividing more of the muscular attachments, allowing the implants to migrate more medially. This could only be determined by physical exam.  In general, the gap always seems to be visually more apparent with high profile implants accentuating the 'rift'. So, an implant change to an intermediate profile implant, and possibly a wider implant, might also help this visual issue as well.  

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 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.