My Hand Can Fit Between My Breasts After 339 Silicone Implants 10 Months Ago. Any Recommendations? (photo)

Question

5'5 120lbs. Had 339 cc (Natrelle Style 15) silicone implants 10 months ago. pre-34A. post-34C. Happy with the size and shape but unhappy with the space between breasts. Can fit my whole hand between breasts when standing and was hoping for a 2-3 finger space between without bra. PS recommended wider (style 10 i think) and slightly larger(400cc) to bring them closer together. Will this lessen the space or will I just have really big side breasts sticking out with off center nipples?

Rian A. Maercks, MD · Answer

Your results are typical of those with high profile implants and dual plane technique.  I have attached an educational video that explains how switching to subfascial with low profile implants will give you a much better result.  I hope this helps!

	 

	All the best,

	 

	Rian A. Maercks M.D.

Stuart A. Linder, MD, FACS · Answer

A larger silicone gel implant will certainly help with cleavage and maintaining better volume. A high profile implant and increased cohesive will reduce the risk of visibility and rippling.

Gary M. Horndeski, MD · Answer

Prior to surgery you were a 34 A and now a 34 C.  Your photographs show a wide space between the breast mounds as well as the nipples pointing laterally.  You need to have your breasts re-operated on through a circumareola incision.  At that time, the pockets have to be dissected medially and plications placed laterally to move the breast more central.  Your breast tissue will also need to move medial. You will need the skin excised so that the nipples are centered.  The combination of the movement of your nipple, your breast tissue and your implant medial will give the cleavage you desire.  This can be done without larger implants if you are happy with your current size.

	Best of Luck,

	Gary Horndeski, M.D.

Robert Brueck, MD · Answer

It looks as though the space betwen your breasts needs to be narrowed by redoing the pocket.You have to be careful you don't release too much medially and get symmastia or one large breast.

David Bogue, MD · Answer

Improving cleavage with implants for women with a naturally wide separation of their breasts can be a challenge. There are two basic steps which can improve the situation however. The two steps include subglandular placement and lower profile implants. By switching to a subglandular plane, the restrictions of a wide sternum and pectoralis insertion are bypassed. In other words, the implants can be moved as close together as on wishes without detaching any muscle. Unfortunately, this can lead to a problem of medial breast rippling from thin overlying tissues or the more serious complication of symmastia. A wider, less projecting implant can help with distribution of volume along the medial borders of the breast improving the appearance of cleavage. This can also help prevent the appearance of the nipples pointing off to the side when a narrower implant is moved medially rather than remaining under the central portion of the breast. Of course, this can also mean more volume laterally and a feeling of excessive breast under the arm.

	The bottom line is that your breast anatomy is what it is. Implants augment this anatomy. This is why asymmetries become much more obvious after an augmentation. Techniques to improve the cleavage zone of the breast can work but there is an inherent risk of long-term problems with implant visibility, tissue thinning, and abnormal breast shape. The simpler approach is to place implants for breast volume and use an appropriate bra to create cleavage.

Tom J. Pousti, MD · Answer

Thank you for the question and picture.

	In-person examination will be necessary to give you the best advice. For example, if your breasts move off to the side when you lie down, then you may benefit from internal suture repair (capsulorraphy)  to help keep the implants closer to the  cleavage area. This maneuver  along with larger/wider breast implants may be helpful in achieving your goals. Of course,  a detailed communication of your goals will be necessary prior to making any definitive recommendations.

	Best wishes.

Daniel Kaufman, MD, FACS · Answer

It looks like you have a large distance between the nipples, which may have been present preoperatively. Since that is the most prominent and visible part of the breast, their position will determine how "good" you look. Changing to a larger implant will bring the breasts closer together, but may result in off-centered nipples, which may look odd. Switching to a lower profile, same-sized implant in the subglandular or subfascial position may be the best choice. Hope this helps and good luck.

Kamran Khoobehi, MD · Answer

The result of the breast augmentation will depend on the patients breast,surgeon's skill and implants. I would guess that you had very wide gap between your breast before surgery. Your after pictures show very lateral nipple and also some degree of scoliosis that causing right nipple push laterally. Your issue will not be corrected by going bigger or changing the implant position.

Jeffrey M. Hartog, DMD, MD · Answer

The final result depends first and foremost on the preoperative spacing of your breast. So if your breasts had a tendency to diverge prior to your augmentation, then changing to subglandular will allow the implants to be placed more towards the middle, and take the effect of the muscle pushing the implants to the side, out of the equation. Subfascial is a new term for subglandular, but some of us have always done subglandular in a subfascial fashion. There is no data that I am aware of that looks at the long term capsular contracture rate of subfascial as separate from subglandular which is not done in a subfascial way. So for the time being, I still caution my patients that subglandular (subfascial) may still have a higher capsular contracture rate than submuscular. Other options to consider are adding fat grafting towards the middle of the breast, and this can be done with both submuscular and subfascial or subglandular. I have attached a link to an example where larger implants were place, still in a submuscular position, but fat was grafted at the same time.

Ronald V. DeMars, MD (Retired) · Answer

If you had that same degree of gap before surgery, then it is likely you will maintain a wide gape after surgery. If not, then a revision will help you.

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