I want the cleavage look when my breasts are naked. What is the best implant to obtain this? (photos)

Thank you for the question and pictures. In order to achieve the outcome you are looking for, you may benefit from the use of larger breast implants and/or adjustment of the breast implant capsules (capsulorraphy).  Internal suture “repair” of the capsules will allow the breast implants to sit closer to the cleavage area and prevent the lateral displacement of the breast implants when you are standing or lying down. Best to seek in-person consultation with board-certified plastic surgeons who can demonstrate significant experience helping patients with revisionary breast surgery. It will be important for you to communicate your goals carefully with your plastic surgeon; in my practice, I find the use of goal pictures very helpful during this communication process. You may find the attached link, dedicated to revisionary breast surgery concerns, helpful to you. Best wishes.

The first thing to consider is that the implant base diameter needs to be wide enough, so high profile is the least likely to do that because they add projection more than width. The second factor is that implants under the muscle cannot move any closer than the muscle attachment will allow. Trying to get them too close together risks symmastia. Going over the muscle would allow them to come closer together but you would lose coverage and possibly see rippling. Sometimes an internal bra procedure using Strattice, SERI scaffold mesh, or Gala FLEX mesh can help hold the implants up and in.

Since 375 cc implants did not give you the cleavage you desired, it is unlikely that 475 cc implants will.  Implants only add volume, however, you are trying to change the shape and position.  I recommend a new technique called Breast Augmentation with Mini Ultimate Breast Lift(TM).  Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall maximizes anterior projection with a minimal size implant.  Small round textured silicone gel implants placed retro-pectoral look and feel more natural, are more stable, less likely to ripple or have complications needing revision.  Implant profile is irrelevant in the retro-pectoral position since the muscle compresses it.  Using this technique it is possible to achieve the cleavage you desire using smaller implants which are stable and eliminates the side boob which is undesirable.  22% of women who undergo breast augmentation alone require revision within 2 years because they are dissatisfied with the result.  Repeating implantation will not solve your problem.Best Wishes,Gary Horndeski, M.D.