Breast augmentation is the relatively simple procedure of placing an implant underneath one’s existing breast mound. By so doing, the existing breast mound is changed by enlargement. What is not obvious to most patients is that although the breast becomes larger, many of its pre-surgical features remain.
An implant can change breast size and to some degree its shape but certain things they can not do. One of these unchangeable features is the spacing between the breasts or how far apart they are. Women are often bothered by a big gap between their breast mounds or how wide apart they are. When the breast mound sits way to the side of the chest wall and the nipples do not point forward, these are widely spaced breasts.
One of the common questions that I get in my Indianapolis plastic surgery practice from breast augmentation patients is that they do not like the gap between their breasts. They often feel that breast implants will correct that problem. Unfortunately, this is often not the case. The breasts will become larger but they will still be very much to the side or the interbreast gap will still exist.
A breast gap can be reduced by positioning the implants as close as possible. This is easier to do when the implant is above the muscle than below it due to the sternal attachments of the pectoralis muscle. A larger implant makes this more possible than a smaller one. But the closeness of the breast mounds after augmentation is as much a function of one’s natural anatomy than surgical technique.
I often point out to patients that cleavage is a function of wearing a bra and not caused directly by breast implants. Trying to create cleavage by implants alone runs the risk of what is known as synmastia, where the implants actually  touch across the sternum. This is a difficult problem to correct and is best avoided.
While most prospective breast augmentation patients have seen photos of implanted women with great cleavage, such results are not possible for many women. Their naturally wide-spaced breasts do not permit such outcomes. One has to have realistic expectations given what one has to work with.
Wide-spaced breasts can have nipples that are oriented or point to the side. I call this wall-eyed breasts. Once implanted, this nipple orientation can be exaggerated even if the implants are well placed and symmetrical. One small procedure that can help this problem is a medial or inward nipple lift. By removing a small crescent of skin on the inside of the nipple, the nipple is moved further inward. This small procedure can help provide some nipple re-orientation.
Dr. Barry Eppley
Indianapolis, Indiana