Tori Spelling’s Boob Gap!

Why do we associate specific plastic surgeries with specific people (or celebrities)? I have now fielded my fiftieth request (at least) that goes something like this: “make sure you put my breasts close together – I don’t want to look like Tori Spelling.”

While we’re on the subject, let’s talk about what identifies this particular celebrity with the issue at hand.  Tori has the unfortunate claim to fame of having breasts that are too far apart, producing a Grand Canyon-esque gap in her cleavage. See the photo — no amount of push-up or push-in seems to be able to close that valley!

Generally a gap like this — we’ll call it “gap-osis” — is formed by the implants being too far apart, and with some capsular contracture (explained below), it really shows off the problem.

Tori Spelling

Also, the exact shape of the implant is clearly visible because it is not submuscular (hidden under the muscle).

So, how do you fix this “gap-osis”? 

The fix can vary depending on the problem. The capsule, which is essentially the scar tissue surrounding the implant, can be released near the sternum, allowing the implant to move inward. The capsule over by the outside of the breast can be tightened. These changes together migrate the implant pocket further toward the middle, making it hard for the problem to ever come back.

If the capsule is too tight (capsular contracture), it can be released, with or without using a dermal matrix product (like Alloderm). Finally the whole shebang can be moved under the muscle, but I think the decision to do this really depends on the patient, the width of the sternum, the location of the muscle, and the previous surgery before the final decision is made to do that. Personally I am more willing to switch to a submuscular plane if implant visibility, rippling, and contracture are significant problems.

Get it right the first time! 

Avoiding implant positioning problems from the beginning is always best. Simple best practices like using an appropriate size implant (just narrower than the width of the breast), placing them submuscularly, and keeping them medial and out of the armpits — these alone can make a world of difference. Now I always minimally dissect the area laterally, which keeps it in and looking good. So before you get a breast augmentation, ask your surgeon what technique she (or he) uses in order to position your implants properly.

Copyright (C) 2011, Lisa Cassileth, M.D.

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