DR. EPSTEIN’S COMPREHENSIVE Breast Augmentation Guide

Anesthesia – General, Sedation or Local?

How Far Apart Will My Breasts Be? Will I Have Cleavage?


A common concern of women undergoing breast augmentation is how far apart will the breasts be. The answer depends upon how far apart your breasts are before surgery. This distance varies among women, but the thing to understand is that you cannot change this distance, even with surgery. This is your natural anatomy that you were born with. The implants are placed under the pectoralis major muscle on your chest. This muscle is attached along the side of your breastbone (see diagram below). This line of attachment determines the inner border of the pocket that contains the implant. It is for this reason that the implants cannot be any closer together than the distance between the breastbone attachments of the right and left pectoralis major muscles.

Also consider the following: The implant size is determined based upon the base diameter (base width) of your breasts. If your breasts are naturally far apart before surgery, then if you choose the correct size implant for your breast dimensions and tissue characteristics, then the breasts will still be far apart after surgery.


Let’s Assume That You Have Naturally Far Apart Breasts And Are Willing To Accept The Risks Of Bringing The Breasts Closer Together – What Are Your Options?

Now, let’s assume that you want to make the breasts closer together anyway, not a smart choice, but here are your options:

1. You can select an implant that is much larger than desired for your breasts – this will allow the medial, or inner aspects of your breasts to lie closer together (and the outer edge of the breasts to protrude further away from the side of your chest wall as well), however, this will not come without a price – increased atrophy of breast tissue, increased discomfort during recovery, increased chance of creating an uncorrectable deformity,  increased chance of the crease of the breast dropping with bottoming out of the breasts requiring a second surgery to try to correct this. To see what this looks like, click here.

2. You can use the correct size implant but just place the implants closer together. This may make the breast mounds closer together, but understand that you cannot also move the nipples closer together (or further apart for that matter as well). Now you will have breast mounds closer together but the nipples will sit way too far over on the outer side of the breasts which would look ridiculous. It would look the direct opposite of “cross-eyed.” The lesson here is the implant must always be positioned under the breast so as to position the nipple on the correct place over the breast mound.

3. The only way to make the implants closer together is to either place them above the muscle which is highly NOT recommended for several reasons (less soft tissue to cover the implant rendering in more visible and palpable, increased wrinkling and risk of synmastia) or to cut the attachment of the muscle to the breastbone which will leave only thin skin above the implant which may cause permanent rippling above the implant alongside the breastbone and also risk synmastia.

Submuscular Implants

Initially, the breasts are firm and stiff. They will not move very much, if at all. During this time, the breasts may appear far apart. However, as the breast tissues relax in the ensuing months following surgery, the breasts will become more movable and cleavage may be able to be created with clothing (bra, bathing suit top, etc). At this time the breasts will appear more natural. If your breasts are tight to start with, this process of maturation and softening may take a year, occasionally a little longer.

Will I have cleavage?

Cleavage is just excess inner breast tissue being pushed together by a bra. Breast augmentation will increase the amount of inner breast volume, however, how closely the breasts will be after surgery will be a factor of how much natural tissue you have in the inner breasts to begin with, how close the inner aspects of the implants are after surgery as detailed above and how much the natural breast tissue will stretch after surgery.

A special word to those with tubular or constricted breasts:

Tubular breasts and constricted breasts are a spectrum of disorders (I really hate that word “disorder” because it really is a variation of shape, rather than function – if you have a better word, then please email me!). In these cases, the breasts are partially underdeveloped, either just underneath, or sometimes all the way around the base of the breast with normal breast tissue lying under the nipple/areola complex. This makes the breast look like a “tube” in shape. These breasts by nature are often disproportionately narrow as compared to what the expected width would be for the size of the torso overall. As these breasts are narrow, the distance between the breasts will be increased, making them look too far apart in some cases. As these breasts are not only tight, but lack the skin envelope of a similar sized breast on a woman who has more typically shaped breasts, they cannot accommodate as much implant volume as a typical breast of similar size. Therefore, it may be even harder to correct the spacing of the breasts as using the required smaller implant will mean that there will be less fullness towards the midline of the chest.

Examples of breasts that are naturally close together

Examples of breasts that are naturally far apart

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