What’s a breast augmentation “refund gap”?
In a Q&A chat room I was asked the question “how do I avoid a refund gap?” I had never heard this term before so I Googled it. I learned that a refund gap is a situation in which the breast implants have migrated so far apart that there is a large gap between the implants….so the patients request a refund.
After 18 years in practice, I thought I should post a blog and tell you how I avoid this.
As you may know I prefer breast implants placed under the pectoral muscle (submuscular). Implants under the muscle look more natural because they are better hidden, mammography is easier to interpret, and there is strong evidence that the risk of infection and capsular contracture is lower.
When going under the muscle I always place my implants as close to the midline as possible, but without lifting up the pec muscle where it attaches to the sternum. Overly releasing the pec muscle can lead to symmastia, also called “breadloafing” or “uniboob” by some. A patient with a narrower space will have closer breasts; a wider space will result in breasts that are further apart.
The body itself also affects the implant position. Over the first year the pectoral muscle pushes the implants down and outwards. This is why I have my patients massage toward the midline and why cleavage will still always need help from a bra.
Chest shape makes a difference too, when the chest slopes inward (pectus excavatum) implants tend to stay more to the middle. In some cases the chest slopes outward (pectus carinatum) and the implants move more under the arms.
With a subglandular augmentation (just under the breast tissue, not the muscle) implants can be placed closer to the midline but the risk of tenting , rippling and implant visibility make this far less appealing in my opinion.
So, the truth is we always try to minimize the gap but a lot depends upon the patients starting situation. While we always strive for cleavage a bra is still necessary to achieve it in most patients. It is often the patient, more than the surgeon that determines final implant position. As I often say “ the body is smarter than the doctor”…