Beware of chasing the imperfections

In general, you can get more definitive cleavage with implants placed on top of the chest muscles. This is somewhat dependent on what amount and distribution of natural breast a person has to begin with. With the size of your breast you describe, any cleavage in you would come form the size and type of implant.However, you shouldbe aware that breast augmentation is an imperfect operation and you have to be able to accept certain imperfections, otherwise you can end up chasing the imperfections.

While you might be able to increase cleavage with wider implants or by releasing the muscles more aggressively near the sternum, both can have detimental effects. These effects should be fully discussed wth your plastic surgeon. In general, the more you go outside the natural dimensions of your native breasts, the more side effects and long-term complication you might have with rippling, palpability, tissue atrophy, asymmetry, and displacement of the implants. Sometimes, it is better to accept the limitations of your natural anatomy.  

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When breast implants are placed behind the muscle, the surgeon must do a good job of releasing the muscle fibers from the border of the sternum (breast bone) in order that the implant pockets are as close together as desired.  The surgeon must also avoid opening the pockets too far laterally (towards the armpit), as this will also make the implants look even further apart, since the tendency with the implants placed behind the muscle is for the muscle to push the implants downwards and outwards.  The pocket dissection must be precise, because if the muscle is released too far off the sternum, it can create a condition called "synmastia" where the breasts appear joined together across the midline of the chest, which can be very difficult to correct.

The problem of excessive cleavage width after sub-muscular implant placement can be corrected by placing an implant with a wider base diameter.  However, a wider implant alone will not correct the problem if the pocket dissection has been inadequate near the breast bone, or excessive laterally near the armpit, and these problems from the initial surgery must be corrected to attain a better result.

Implants are available in a variety of profiles (diameter vs. projection height) for a given volume in cc's.  To keep the same projection, you would need to choose a larger cc volume.  However, larger implants in general (above 350-400cc) may create problems of their own by causing the breast to "bottom-out" and sag.

Your surgeon should be able to discuss the options and trade-offs available to you to correct this problem.

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Breast implants should be centered on the nipple-areolar complex.  If they are placed too far to the center, the breasts will appear off-center.

Simply placing larger implants creates problems as well.  The muscle in the center of the chest on the breastbone (sternum) must be detached in many patients to allow the implants to go more to the center.  This can cause the chest muscle (pectoralis) to contract in an unusual fashion.  It is also irreversible.

We advise our patients not to go too large with their breast implants.

Patients who have very large implants are at much higher risk for needing multiple redo surgeries, for having rapid sagging of the breasts, and stretch marks.

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The amount of cleavage obtained after breast augmentation is primarily determined by these three factors:

• Volume of implant
• Base diameter of the implant (how wide the implants are)
• Position of the nipple relative to the middle of your chest
• Subglandular or submuscular placement of implants.

Plastic surgeons can do little to change the distance of the nipple from the midline of your chest.  During a breast augmentation, the implant is placed in a pocket that lies below the nipple.  If the nipple is positioned very far to the sides, the implants will be positioned laterally, thus resulting in less cleavage.  The wider the implant that is placed, the better the cleavage.

There are limits to how wide of an implant we can place as the wider we go, the more implant there will be on the sides of your chest. 

Its important to measure these distances before you undergo breast augmentation.  Discuss the position of your nipples and the placement of the implants.  An experienced plastic surgeon can usually predict the amount of cleavage you will obtain based on these numbers.  The more you discuss before surgery, the better.

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