Implants are 5 inches apart, surgeon says its caused by rib cage. What would cause gapping in implants? (Photos)

Dear dreamer4life90,

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

It is important for patients to understand that augmentation will "augment" all aspects of your anatomy. The spacing of the footprints of the breast on the chest wall will vary from one individual to the next. Widely spaced breast will appear more widely spaced and vice versa.
The spacing (cleavage) is defined by the pocket. The pocket is defined by the plane of augmentation.When placed submuscular, the medial/middle limit is the sternal origin of the muscle. Wide sternum greater separation of the breasts less dramatic cleavage. This space can be narrowed (with some risk of synmastia) when the devices are placed subglandular or "over" the muscle. There is no muscle obstructing a medial push, however, there is a higher risk of over-dissection and midline migration of the implant (the dreaded "uni-boob").
With regards to your specific question, it is unlikely that you will see significant changes after 1 year. If your native breasts were widely spaced pre-op then it is unlikely implants can be forced to the middle without sacrificing alignment.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Thank you for your question. I have heard the story so many times and been able to improve the shape of similar breasts. There is no question that you needed a lift from the very beginning. If you want more cleavage, then I would perform a internal bra/capsulorrhaphy procedure. I wrote the very first paper on how to do this in 1999. I have been in practice for over 30 years and revisionary breast surgery is a large part of my practice. You should be able to get exactly the shape and size that you desire. Best wishes to you.

It looks like your nipples are located below your breast fold which means your breasts are sagging. Without seeing a before photo, it would be difficult to say if the sagging existed before your surgery. If it did, a lift would have been appropriate. The lift would have reshaped your breasts to make them fuller and perkier. Cleavage is mainly dependant on how far your breasts are naturally spaced apart, and implants and a lift can can only give you a subtle improvement.

You have not provided before photographs. However, if your breasts were widely separated before implants then the breasts will be widely separated after implants because the implants have to be centered underneath the nipple-areola complexes. At this time, I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

You’re in a very difficult situation, and I’m sorry you had to experience this. It’s hard to determine exactly what happened without seeing your preoperative anatomy or the intraoperative details - surgery is very complex and I never want to say your surgeon did anything wrong. I often counsel my patients before surgery that if their breasts are naturally widely spaced, the implants may also need to be placed wider apart as well. Otherwise, the implants may not sit properly under the breast tissue, and the nipples can end up appearing too lateral or even off-center.
The good news is that in plastic surgery, there are almost always options - though they may require further surgery. However, your options will heavily depend on your physical examination. I perform many breast augmentation revisions, and in your case, potential solutions might include:1. Exchanging your implants for higher volume (larger) or lower profile implant (flatter profile), which would provide more width to better fill the space between your breasts. It all depends on your personal goals.2. Converting to a dual-plane (partially under-the-muscle) placement, which can help shape the lower pole and round out the breast contour more naturally.3. Using mesh or an "internal bra", which can help control implant positioning and support more medial placement, depending on your anatomy.4. Considering a breast lift over the implants.
Ultimately, the best next step is to consult a board-certified plastic surgeon who can perform a thorough physical exam, understand your goals, and create a tailored surgical plan unique for your situation.
Wishing you the best on your journey forward.

The distance between the implants is due to your anatomy and cannot be changed. This distance is unique to the patient. The implants appear to sit low on the chest wall. If you want a "perkier" look a breast lift would help raise the nipple position and give more upper pole fullness.

Surgeons can’t move your breast position on your chest wall. If your breast sit wide apart then the surgeon has to decide if the implants should be centered on each breast or placed towards the midline. If placed closer together you’ll have more cleavage, but the implants will not be centered on your breast.
This should ideally have been discussed during your consultation
Mats Hagstrom MD