Are my breast implants too narrow for my breast width diameter, causing too wide a gap on my chest? (photo)

Question

I had a breast augmentation using 430cc ultra high profile round implants. The diameter of these implants is 11.1cm. My breast width diameter prior to surgery was 14cm on one breast and 14.5cm on the other. I am very concerned since my surgery over the extremely large gap between the implants on my chest, and I am worried that this is due to the wrong diameter of implant being used. Surely I should have had implants which more closely fit with my natural breast width diameter? Please help!

Vishnu Rumalla, MD · Answer

Thanks for your inquiry, the gap between the breast is determined by your sternum width, the muscle dissection and to some degree the width of the implant, but I would say the width of the implant is the least. In general as the width of the implant gets larger it has more effect outwards on the chest.

Ramiro Morales, Jr., MD · Answer

If those are our true pre-op base diameter measurements, I would not have chosen and UHP implant and instead one with a wider base diameter closer to yours, with the caveat that it would have also caused  a little more side breast projection, perhaps something the surgeon was trying to avoid.  Go back to your surgeon and express your concerns.

Rohit Jaiswal, MD · Answer

If the measurements you listed of your breast base width and implant diameter are accurate, this may explain why there is a large intermammary distance (i.e. gap). However, if you are soon after surgery then the results may continue to change in your favor. I usually try to match the implant width closely with the patient's base width, as this will fill out the breast footprint and create the most natural full look. An implant that is too narrow for the base width will not fill out tissues as much as would be desired, while one that is too wide risks the formation of symmastia (aka: uni-boob) or excessive fullness on the outer breast. An ultra high profile implant should really only be reserved for patients with a narrow breast base width who desire a large size implant. Diameters of 14-14.5 cm would be unlikely to require an ultra high profile unless a very large volume was desired. An 11.1 cm diameter is more appropriate for patients in the 11-12 cm base width range. Hopefully there was a discussion between you and your surgeon pre-operatively regarding the impact of profile on implant choice. I explain to my patients that profile really only comes into play when trying to put more volume into a narrower space- I tell them to not focus on profile choice as much as figuring out the overall desired fullness/volume, and whatever profile matches the anatomy best will be the right choice. I counsel my patients to wait until the 6 month mark to know the final results. At that point, if revisions are needed we can discuss it at that time. Consider asking your surgeon about your concerns and about expected changes over the next few months.

Donald R. Revis Jr, MD · Answer

Good morning!You're absolutely correct you need wider implants to fill the gap! I like a nice one finger gap unless a patient wants closer.

Paul M. Parker, MD, FACS · Answer

Discuss this with your surgeon at your next visit. Mostly all of our patients desire as much cleavage as possible. We try to enhance that not only with implants of proper dimension but dissection medially as much as the insertion of the pectoralis major muscle will allow.

Daniel Barrett, MD · Answer

Hi worriedsick89,
  
Breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.
  
Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.
  
While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.
  
If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Also, you may need to wait until after 6 months when your implants have completely dropped and fluffed into their final position. Only after a thorough examination you will get more information and recommendations. 
  
Daniel Barrett, MD, MHA, MS
  
Certified, American Board of Plastic Surgery
  
Member, American Society of Plastic Surgery
  
Member, American Society of Aesthetic Plastic Surgery

William Albright, MD · Answer

Hello,
A couple of issues.  In addition to implant dimensions, the cleavage gap relates to the implant pocket placement and one's anatomy.  There is inherent limitations on how close the implants can be placed when under the pectoralis muscle.  The origin of the pectoralis major muscle is attached to the outside border of the sternum (breast bone).  If the implant is placed under the muscle, the furthest toward the midline you can get the implant is where that muscle is attached on the breast bone.  There is some  room for adjustment as the surgeon can thin the muscle out carefully, but with some risk of disrupting too much muscle.  If this dissection has already been done, then going with a wider implant in this situation will only push that volume out toward your armpit.  With the photos shown, you already have some breast fullness toward the armpit.  
If you want to try to cheat the cleavage in and the muscle has already been released as much as safely possible, then placing the implant above the implant is the only reasonable option.  However going with an implant above the muscle has other downsides to consider.
As an aside, it appears that you may still get a little implant settling (not sure how recently your surgery was).  So maintain a healthy relationship with your plastic surgeon and good luck.
ABPS board certified plastic surgeon

Daniel Schmid, MD · Answer

Your implants may be a bit too narrow based on the measurements you are quoting.  Some patients really dislike when their inner arms rub on the side of the breast when implants are larger.  You should discuss with your surgeon.  Good luck.

Mark A. Schusterman, MD, FACS · Answer

Yes your implants are too narrow, which is often the problem with ultra high profile implants.  You should probably have a minimum of 13 cm width.  Good luck

J. Michael Morrissey, MD (in memoriam) · Answer

Thank you for your question and photo. The diameter of the breast is an important factor in breast augmentation. An implant placed that is larger than the native breast diameter runs the risk of extending too far into the axilla and causing difficulty having your arms hang straight down. From your pictures you appear to have a very nice result!  You have good volume without being TOO large. There is good fullness of the upper pole and the implant is not so large as to extend into the axilla. You may wish to compare measurements such as internipple with your before measurements if  you are concerned about the cleavage. Communicate your concerns with your surgeon. But again, you have a very nice result!Best wishes,Dr. Morrissey

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