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What’s a Breast Augmentation Refund Gap?

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.

The Best Breast Implant Placement

As you may know, I prefer to place breast implants 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 “bread loafing” or a “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.

Natural Positioning of Breast Implants

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, as 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 sub-glandular 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 patient’s 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 the final implant position. As I often say, “The body is smarter than the doctor”. 

Minimize Your Chances of a Refund Gap

Want a more natural look to your breast augmentation? Come in today for a breast augmentation consultation in Maryland, or call 301-656-6398. I’ll minimize the chances of a refund gap and have you looking natural.

October 3, 2012 12:13 am
Categories: Blog, Breast Augmentation

Written by Dr. Adam Tattelbaum

Dr. Adam Tattelbaum is a highly skilled and compassionate plastic surgeon with over two decades of experience.

Double-certified by the American Board of Plastic Surgery and the American Board of Surgery, Dr. Tattelbaum believes in providing personalized patient care and customizes his treatment plans to suit the individual.

Dr. Tattelbaum's candid and realistic approach has earned him recognition, not only with his patients but in the Top Doctor lists of the Washingtonian and Bethesda magazines. He is also a member of the American Society for Aesthetic Plastic Surgery, a mark of distinction in the field of cosmetic surgery.

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