Wide Breast Bone, Breasts Wide Apart, Would a Bigger Implant Help to Have Closer Cleavage?

Plastic surgeons must respect normal anatomy of our patients.  Your natural wide distance between your your breasts are not correctable by breast augmentation surgery.  Trying surgically to close this distance is fraught with possible complications.

Dr. ES

There are a few things that a surgeon can do to try and minimize the wide gap in patients that are prone to it...Not over dissecting the side, moving the pocket over toward the middle a bit, and getting the base width right (and high profile implants actually are WORSE since they are more narrow, exactly what you don't want)..But some patients are still really hard to correct, so discuss all of this with your doctor..They'll know if you have a higher risk or not.

Cleavage is defined by your anatomy. Patients with very wide chests often do not get as much cleavage as they want and certainly whent he implants are placed under the muscle, the cleavage is limited by the muscle insertion.  Sometimes wider implants can give a bit more cleavage.

Great question. The BEST you can do is get an implant which can first be covered by your present breast. That would get you a nore natural feeling breast. Within the group of implant applicable to you, the most attractive would be the Moderate Plus implants (Mentor saline) or Allergan style 15 (gel) or Mentor HP (gel). The slope of your chest would determine how the implants are positioned on the chest and the worst thing your surgeon can do after choosing implants which are much wider than your present tissue cover is over-open the side of the breast implant pocket. This would allow the implants to fall away from one another further increasing the distance between them.

The best way to address your situation is to pick implant that fit you AND to narrow the cleavage by placing fat grafts under the inner skin of the breasts.

Peter A Aldea, MD

Thank you for the question.

It will be important to communicate your goals with your plastic surgeon. He/she will choose implants  that will meet your goals as much as possible,  without causing complications such as implant malposition and/or rippling/palpability  that can arise if surgeons try to “create cleavage”.

Careful attention to creation of the breast implant pocket will help center the breast implants under the breast tissue. Choosing a breast implant size that fits, but does not exceed, the limits of the breast implant pocket will help you achieve as much  cleavage as safely possible.

I hope this helps.

 

I agree with Dr. Stephenson. For maximum control and naturalness on a first time augmentation, the implant width must match the width of the breast and be positioned exactly behind it. Putting in an implant that is too wide for the breast or is positioned beyond the base of the existing breast (except for the lower pole) is asking for problems and distortions that are hard to correct. The best way to expand the base of the breast and get them to look closer together is to do the procedure properly the first time and accept the existing gap. Later on the existing implants can be replaced with wider ones and ask the tissues to accommodate a wider base width without distorting the tissues. This is similar to the process of tissue expansion but does require a second procedure and a new implant. The increase in base width of the implant can usually be about 1 1/2 cm or so.

The profile of the implant is a separate issue and has to do with the forward projection of the breast out to its edge. The higher the profile, the steeper the cleavage into the gap between the breasts, so high profile implants actually make a wide gap look worse. I would start with a medium profile implant and consider a secondary augmentation later on. 

I recently had a patient describe the wide gap in the middle from inappropriately chosen breast implants as "Death Valley."  Pretty descriptive.  Some patients are predisposed to more width than others but as long as the implant that is chosen is WIDE ENOUGH (not a profile issue), you can fill in the gap.  Also, make sure the lateral pocket is not opened too far.

A wider based implant can sometimes help give a little more cleavage but can also create more fullness laterally.  Your surgeon will need to take care with the pocket dissection to help give you the best cleavage possible but your own anatomy is going to dictate the most as to what the end result will be.  Pocket dissection and implant selection can only do so much.  I have seen several patients where the surgeon worked a little too hard to give cleavage and ended up with the midline skin lifting off the chest wall creating just one large breast and this can be difficult to fix.  Just make sure that you are seeing a Board Certified Plastic Surgeon and make sure you express your desires fully.

Gary Hall,MD