Do I need a revision to have cleavage? (Photos)

Question

Hi im 26F 5’0 123 lbs and wondering if I will ever get cleavage after breast Aug? This is my result after breast augmentation and feel that I can’t see much cleavage on the top and wondering if I need revision

Finny George, MD · Answer

Hi, thank you for sharing your question. From the photo, it appears that the surgery was recent (?). If so, the cleavage will improve once the swelling resolve. The amount of cleavage is often limited by the muscle insertion if the implants were placed under the muscle.

Ira H. Rex III, MD · Answer

I cannot give you much advice based on your photograph.  It is difficult to see any relationship between the breasts.  Often cleavage is determined more by your anatomy than the surgery itself.  It is usually best to return to your doctor and discuss the issue.

Chet Mays, MD · Answer

Thank you for your inquiry!  We would love to meet with you to discuss your concerns.  Schedule a consultation with a Board-Certified Plastic to discuss your goals.

Leila Kasrai, MD, FRCSC · Answer

Cleavage can only be improved to a certain extent with breast augmentation. As a result, while choosing a wider implant base width may help a bit, the amount of cleavage you have after surgery is largely determined by the amount you had before. This is because the implants are centred behind the nipples, and placing them too close to each other can cause the nipples to point unnaturally outward. Therefore a revision would not help.

Daniel Barrett, MD · Answer

Dear Energetic174940,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Donovan Rosas, MD · Answer

It is important for patients to understand that augmentation will "augment" all aspects of your anatomy. The spacing of the footprints of the breast on the chest wall will vary from one individual to the next. Widely spaced breast will appear more widely spaced and vice versa. 
The spacing (cleavage) is defined by the pocket. The pocket is defined by the plane of augmentation.When placed submuscular, the medial/middle limit is the sternal origin of the muscle. Wide sternum  greater separation of the breasts  less dramatic cleavage. This space can be narrowed (with some risk of synmastia) when the devices are placed subglandular or "over" the muscle. There is no muscle obstructing a medial push, however, there is a higher risk of over-dissection and midline migration of the implant (the dreaded "uni-boob").
With regards to your specific question, a higher profile device is narrower but will project more. A wider device can create the illusion of closer spacing between the breasts (when placed subglandular). Most patients will fit into the "moderate +" category...but this will depend upon the measurements of your breast width. That being said, it is never recommended that you stray far from your unique BWD.
And remember...love the look you choose...not the cup you desire.
Based on your photos alone (which appear very early), you have a very reasonable result. Much will change in the months to follow. Cleavage is typically defined as the space between the breasts at midline. This is generally not changeable. If your concern is upper pole fullness a higher profile/larger implant may be an option.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Gene Sloan, MD · Answer

The photo appears to be right after surgery, perhaps even in the recovery room. You need to let it heal for 3 months or even more to make judgement on the result.  Express your concern to you surgeon and they can explain further as they have more information.

Ram Kalus, MD, FACS · Answer

From your one photo it is far too early to be disappointed. It takes time for your breasts to get used to your implants and the implants to get used to tour breasts. The swelling will settle, the skin will relax, and your breasts will be more mobile over time. At approximately six weeks to three months, your result will be more evident. If you remain disappointed, discuss your concerns with your plastic surgeon. In the mean time, I would recommend trying to celebrate the new you rather than focus on your disappointment. Best of luck to you.

Ted Eisenberg, DO, FACOS, FAACS · Answer

Implants give more volume, a fact which makes it easier to create cleavage in clothes. Aggressive surgery to bring breast closer together can often lead to symmastia (the appearance of one connected breast). Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Joe Gryskiewicz, MD, FACS · Answer

You look good. Please give your implants six months to “drop and fluff”.
If you are under the muscle then you can only got so close and the muscle stops the implant. You need to go on top of the muscle (but under the fascia - subfascial) to obtain more reliable cleavage. Give it lots more time.