I recently posted a question whether to get sub muscular or sub glandular implants and the feedback was most helpful in my decision. I'm leaning toward sub muscular 300cc silicone because I believe this will fill out where I am flat in my upper chest while looking most natural. My question is will this size and placement be enough to give me more cleavage? I've read that submuscular placement gives the chest a wider cleavage and I want to fill my breasts out and achieve more cleavage, not wider.
Sub Glandular Vs Sub Muscular Implant for Better Cleavage?
Doctor Answers 15
What "is" cleavage?
In the past year, many of my patients have been calling "cleavage" the roundness in the upper pole of the breast, similar to what a push up bra does. Most of us who are older (and since Board Certification take so long, Plastic Surgeons who are Board Certified are a bit older) consider cleavage to be what is between 3 oclock and 9 oclock of your breasts. So we first need to know the right definitions. You speak of wanting your breasts to "fill out, not be wider".
If it is the roundness that you wish in the upper pole, then a higher projection device would help with that. Technically, being on top of the muscle would help with that even more, but the complication rate is higher as well. Because of the higher rate of capsular contraction, and the possible difficulty in seeing the beast tissue as easily on mamography when the implant is on top of the muscle, I am not a big fan of on top of the muscle approach. At the end of the day, we would like to cut down on complications, and reoperations, as these really decrease the satisfation rate of patients with their overall experience. So if it is roundness in the upper pole that you wish, go for a higher profile implant.
On the other hand, if you wish to have less space between your breasts (traditionally thought to be "cleavage"), you would get less space between with a lower profile implant, like the "moderate" profile silicone. Silicone implants can be much wider than saline in diameter.
Your pictures show that you have a bit of pectus carinatum or "pigeon chest", which tends to push the implants out to the side. This is just your foundation, and we cant change that (without breaking your ribs and sternum). So physics says that your breasts will go out to the side more than someone who has a chect that is pushed in at the sternum (pectus excavatum). We cant get water to run uphill. And gravity and the push of your pectoral muscle will be to push your implants slightly more to the side over time.
So you have many factors involved, and you have to make the choices knowing that their are pros and cons with whatever your decision might be. Go to your Board Certified Plastic Surgeon who is a member of the American Society for Aesthetic Plastic Surgery (ASAPS) and have a consultation to go over all of these complex variables. An ASAPS memeber does the majority of his Plastic Surgery in Aesthetic (Cosmetic) Plastic Surgery. Good luck in getting your new wonderful look!
Does Implant Pocket Placement Determine Cleavage?
Wow, TMI. As you can see, so many questions to answer. Of course, the right answer here is to pick an excellent, experienced Board Certified plastic surgeon, and then allow him or her to do all the heavy work (the stuff above).
Aiming for better cleavage
Subglandular placement will give you more implant visibility, and may allow you to have the implant more medially which translates to a 'better' cleavage. However, for ideal breast augmentation the implant should sit behind your breast. If your breast naturally sits more to the side, trying to place an implant closer to the middle will make the natural breast tissue look like it's falling off the side of the implant. That is not a nice look. Your pictures show a certain space between your natural breasts. That same width should be expected after your surgery. For the 'optimal cleavage', a good support bra will be your best friend.
Martin Jugenburg, MD
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Cleavage depends on your natural breast positioning
Post-operative cleavage will depend on your pre-surgery cleavage. You have wide-set breasts, which means you'll probably continue to have wide-set breasts after surgery. However, while you may have a bit of improvement, it may not be as much as you want. Unfortunately, your surgeon can only do so much to give you cleavage before it looks abnormal, since the implants have to remain centred underneath your nipples.
Sub Glandular Vs Sub Muscular Implant for Better Cleavage
Submuscular breast implants will provide better cleavage
There are many advantages to having your breast implants placed in a submuscular(subpectoral) position. It is easier to perform mammograms, there is a higher likelihood of breastfeeding and a lower incidence of capsular contracture (scar tissue). Also, your cleavage will look more natural with implants under the muscle.
Implant placement (over or under the muscle) has nothing to do with cleavage because the implant sits behind your breast, so that whatever cleavage (the distance between the breasts) you have now will be the same post surgery. If you want to create more of a cleavage then you need good push up bras. As for over vs under muscle implant placement, I prefer under the muscle.
Subglandular placement of breast implants
Breast Implants Placement
There are a number of compelling reasons for selecting subpectoral placement over submammary placement. The most significant is that fact that radiologists have indicated that it is easier to image breast tissue by means of mammography when the implant is subpectoral. The pec major also provides an additional layer of tissue to conceal breast implants in the 'social aspect' of the breasts - that part that is easily visible in swimsuits and lower-cut clothing. Additionally, the pec major is quite effective at flattening the upper pole of a breast implant so that a natural slope for the upper aspect of the breast is created.
Implants placed on top of the pec major tend to look very convex in the upper pole. The breast begins quite 'abruptly' in the upper aspect of the chest, and the appearance is therefore distinctly unnatural. Submammary implants are also more likely to have visible implant folds and ripples in the cleavage area. Another consideration is the fact that there is some evidence which suggests that the risk of capsular contracture may be lower with subpectoral implant placement. Even if the risk of contracture is the same, a mild contracture tends to be less noticeable and therefore less of a problem for the patient when the implants are in a subpectoral position.
Submammary placement may produce a reasonable result for fuller figured patients with larger starting breast volumes, as the larger amount of natural subcutaneous fat and breast tissue helps to conceal the implant contours. The problem is that as breasts age, they tend to deflate - especially in the upper pole. So what was adequate implant coverage in the cleavage area at age 27 may be inadequate coverage at age 37, and implant folds and ripples gradually become visible. So subpectoral placement is the best choice for both the short and long term.
Cleavage is more dependent on the bra and the shape of the chest rather than the implant position. . In this picture the sternum is more anterior than the ribs and the ribs flat surface is pointing away from the mid line so the implants will tend to be more lateral leaning and not medial leaning. The bra will make a bigger difference in the cleavage here.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.