4 years post-op breast augmentation. Why do I have dents by my sternum? How do it fix them?(photos)

The "divots" are a result of your tissues having thinned, the convexity of your sternum,and  the descent of your implants.  One way ti improve this is to add fat to the area that has thinned.  This can be done with very little down time.  It is often combined with removing fat from an area where you don't want fat, like the waist or abdomen.  Be sure to see an experienced Board Certified Plastic Surgeon for a proper evaluation. 

Hello,Prominent or projecting sternums (pectus carinatum) present a problem with breast implants, typically causing the implants (especially round smooth ones) to glide off to the side, leaving irregularities caused by the ribs, sternum, or pectoralis muscle. There are few ways to fix this, including repositioning the implants or repositioning new implants (textured), and/or fat grafting the inner breast/sternal area. Go visit a few ABPS certified/ASAPS member surgeons who specialize in breast surgery. Best of luck!

The dents you are seeing are likely due to the fact that you are slim and there is very little natural tissue covering the  area. When the muscles are lifted to place the implants, some additional loss of volume occurs in that area. To treat this, you should see a plastic surgeon to discuss fat transfer to the area or possibly replacing or removing your implants and reattaching the muscles back to the chest wall in that area. 

Dear hannah78,many women seek improved cleavage. Narrowing the cleavage plane can be done very carefully by a skilled surgeon. Moving the implants too far medially can result in synmastia or unaboob which is very difficult to correct. That being said, the right amount of pocket dissection and implant selection can create excellent cleavage. Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Although it is difficult to say for sure without examining you, these "dents" likely represent a valley between the prominence of your pectoralis muscle above and your implant below. This could possibly be corrected by fat grafting to this area in order to fill in the valley, or by placement of an acellular dermal matrix in this area. Best to see a plastic surgeon who specializes in revision breast surgery for a full evaluation. 
Emile N. Brown, MD
Johns Hopkins & Harvard Trained Plastic Surgeon

I think the dents are related to a couple things: thinning of your natural tissues medially, a step-off created by the boundary of your pectoralis muscle, and slight lateralization of your pocket (your implant sits further lateral on the affected side).  The solutions to fix this include any combination of targeted fat grafting in the area, release of the muscle edge, and tightening of your pocket laterally.  Hope this helps!  As always, seek proper consultation before treatment and best of luck!

An in person consultation is necessary to give you the best opinion.  Fat transfer alone may help or in combination with a new implant.  Fat transfer works great for patients who have a large gap in between their breasts.  Hope this helps. 

Thanks for sharing your photos and question.   It would be great to have some before photos to compare.   Were your implants placed under the muscle?  The dents could be due to inadequate release of the pec muscle medially.  There are slips of muscle that originate from the rib in this location and can be the causing these dents.Best wishes.

Sorry for your problem but the good news is that it can be corrected.  So go on some complimentary consultations with experts and compare recommendations and become fully informed about the desired procedure after a full examination Dr Corbin