Is it possible to achieve cleavage with a larger implant despite having wide-spaced breasts and thick skin? (Photo)

Dear i_am_a_dreamer,
many women seek improved cleavage. Narrowing the cleavage plane can be done very carefully by a skilled surgeon. Moving the implants too far medially can result in synmastia or unaboob which is very difficult to correct. That being said, the right amount of pocket dissection and implant selection can create excellent cleavage.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

You have nice cleavage now, but you can go some bigger. Please do not go too large or you may have tenting at your cleavage. Your breasts are not wide apart, but bras can push them together.

Breast augmentation outcomes are generally based on three variables.
The first is patient candidacy, the second is the choice of implants and the third is the surgeons ability to place an implant in the correct anatomic location.
Whenever there are issues with outcomes, it can usually be traced back to one or more of these three variables.
Variables that affect patient candidacy include anatomic locations of the breast on the chest wall, like wide set breasts, breast divergence, breasts ptosis and more.
Divergence tends to be amplified with augmentation.
The bigger the implants are especially high profile will simply make the divergent more obvious.
The implants should be centered on each breast, not where you want your breasts to sit.
Plastic surgeons cannot move your breast on the chest wall.
it may be possible to move the implants medially but doing so will cause your implants to not be centered on your breast.
Using larger implants will increase the chance of undesirable side effects, complications and the need for revision surgery.
275 mL is fairly conservative and I think it would be safe to increase implant size. Doing so will amplify the divergence.
Take a look at your before and after pictures to see how the implant affects the look.
Patients who have significant asymmetry or less than ideal breast, anatomy will sometimes simply put that on display by augmenting the breast.
I generally advise patients against choosing larger implants than can fit anatomically based on your breast diameter.
Each plastic surgeon will have their own way of guiding patients through the implant selection process.
Some providers have the patient make the ultimate decision regarding the implant, and some providers will make the decision based on input from the patient.
Some providers do this better than others.
I don’t think having tight skin would prevent you from having a larger implant, but as I mentioned earlier, using larger implants will definitely increase complications and revision rates.
Implant greed is very real and I generally recommend women resist the temptation.
To me personally I think your breast look great and I think there’s something to be said about leaving good enough alone.
I think most plastic surgeons would be happy to revise your augmentation and give you bigger implants.
I see nothing inherently wrong with doing that but recognize that there are implications.
Best,
Mats Hagstrom MD