Implants Too Far Apart? (photo)

I am a male to female trans and am NOT on any hormone treatment. I had implants in June, the surgeon used 445cc high profile textured implants. Post op I noticed there was a large gap between implants. My first review I mentioned this and was told that my nipples were quite far apart and also I have a wide sternum. I was told to wait 6 months for them to drop and fluff, I still cant see how the gap will be closed up. If this is the case what are my options to have the gap made smaller? Mandy

Doctor Answers 6

Your implants are not too far apart; you have the "wrong" implants.

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Thanks for including photos; they really help us give useful information! Your pre-operative photo shows a very thin, muscular chest with prominent ribs medially. Your post-op photograph shows immobile (textured) implants centered properly beneath each nipple/areola complex. Unfortunately, the diameter of your implants is too narrow, and your wide gap between implants (cleavage) allows the ribs to draw the eye to this area. Though a push-up bra might help somewhat, the textured surface of the implants minimize movement, giving you a high, tight, "Baywatch coconut" appearance that is decidedly unnatural and not considered aesthetically-pleasing by most (not all) individuals. A bra cannot push together breasts that move very little!

Being M-F transgender usually means more laterally-placed nipple/areola complexes, tight and thicker pectoralis muscles, and a proportionately larger/taller torso, requiring large(r) implants to give you a natural proportionate breast size, and in the widest base diameter for the volume of implants chosen. This usually means moderate profile for all but the largest implants, where moderate plus might be appropriate. High profile implants are simply too narrow, as your post-op photos clearly show. Asking for projection is fine, but using implants that are too narrow simply to give projection is the error you now have.

Dropping does indeed occur, but only with smooth implants. Textured implants by definition cannot drop, since the texture "adheres" to your own tissue, preventing movement. They may well feel softer as edema (swelling) diminishes and your own tissues stretch a bit, but if the texture "works" as it is designed, they pretty much "stay" where your surgeon puts them. I believe "fluffing" is a term that is used in the adult film industry and has no place in describing breast surgery recovery (but I do know what you mean).

Your options are to wait for at least 3 months (6 months is better) before considering re-do surgery for the widest implants (moderate profile) at this volume, or perhaps larger implants with correspondingly wider bases, likely also moderate profile, but certainly not more than moderate plus. I would also recommend smooth round implants that will have a natural teardrop shape when upright, and a natural round flatter appearance that drops slightly to the side, just as naturally-larger breasts move. Waiting allows your tissues and scarring to soften and mature, making subsequent surgery more effective in achieving your goals. BTW, your surgeon will need to enlarge your pockets medially (for sure) and likely laterally a bit as well, to keep your new implants centered, while achieving the narrow cleavage you should have.

You should not use your present implants and try to move them medially; this will give you a "wall-eyed" nipple/areola position. You need more implant width, and perhaps more volume as well, still centered beneath your nipples. For several of my transgender patients with breast augmentation, click on the web reference link below. Note the difference between single stage augmentation, two-stage augmentation, and single stage with re-do for larger implants. Best wishes! Dr. Tholen

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Implants Too Far Apart?

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I find that these implants are positioned correctly behind the nipples and areolas, They are more  widely separated that desired because the nipples and areolas are also. I doubt much will change over the next two month but I agree that it does make sense to wait. 

At that time, consider switching to a lower profile implant (moderate or moderate plus) to get more centralization. I'm looking at a US product sheet, so it looks like the same volume with a moderate profile implant is about 2 cm wider, which will add one cm to the medial fill and another cm laterally. A larger implant would allow for still more medial fill. 

Some fat grafting might blend the medial surface to the chest wall a bit better, but I would doubt that there is much fat to harvest. 

Thanks for your question, best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Large Gap Between Implants

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Thank you for the question and the pictures. Looking at your pre operative photos your nipples were already wide to begin with. The implants are in the right position, just not wide enough to fill the gap. Implants are placed so that in essence the center of the implant is behind the nipple. If the implants were to be placed closer, so as to diminish the space between the breasts, your nipples will be "pushed" further outwards. It appears that you require a larger implant of lower profile so that it has a larger width. This will decrease the "gap" but will cause your breasts to protrude out further on the sides.

I hope this helps. Good luck.

You are probably a better candidate for MP type implants

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Thank you for the question and photos.  Your implant width is narrower than your proposed post op breast width.  To achieve better cleavage and less "gap" between your breasts you will need to have your current breast implants  exchanged from HP to MP.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Implants too far apart

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Cleavage is not created by implants only by a bra. Larger implants will usually migrate laterally with time.

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon


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to start with your nipples hah a big gap before surgery. After surgery the gap will remain. The only other thing you can do is get bigger implants to get cleavage.


Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

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