I am writing to ask about my cleavage. Is it possible to improve cleavage with a breast augmentation revision? (Photo)

My whole hand fits flat against my sternum. Is it the implant or surgical method? Would a different shape, size, or profile help? Am I stuck with this? I like the size and appearance, but maybe a cup size larger and perkier profile. I won’t do a revision unless I can improve the overall look. Sideboob is OK. I’m open to a higher profile if that will improve cleavage. Details: 5’10”, 160 lbs, 38D bra. Mentor smooth round moderate plus profile gel (575 cc left, 525 cc right), sub muscular.

Doctor Answers 7

Breast augmentation - would like more cleavage if possible

Thank you for asking about your breast augmentation revision.
  • Your photos suggest that your implants are sitting low and to the side of your chest.
  • It also appears that your nipples tend to be a little lateral (to the side).
  • And it is possible that you have a capsular contracture.
  • I suggest you return to your surgeon to discuss whether a revision with capsulorrhaphy(change in the pocket) and capsulectomy (removal of the capsule will be helpful.
  • Always see a Board Certified Plastic Surgeon.
Best wishes - Elizabeth Morgan MD PHD FACS

Is it possible to improve my cleavage through revisionary surgery?

Hi and thank you for providing photos. I would be interested to see your pre-op photos to see exactly where the “footprint” of your breasts started. While the natural position of your cleavage is a limiting factor, improvements can be made in your case. Using a wider implant and revising the pocket would help, but I would need to examine you in person to know exactly what would need to be done beyond that. I would recommend that you see a board certified plastic surgeon who does this type of revisionary surgery often to be examined and to discuss your options. Good luck!

Ashley Gordon, MD
Austin Plastic Surgeon
4.9 out of 5 stars 31 reviews

Possible to Improve Cleavage?

When considering revision surgery I find it useful to analyze what went wrong if for no other reason than to avoid the same problems with a revision. Pre-operative photos would be useful, but the photo you have provided gives a good indication of where you started. The position of your breast and nipple are much more laterally positioned on your chest wall and you evidently had a wider than normal space between your breasts to start out. Your chest wall also slopes downward to the outside which contributes to the problem. The poor outcome is a combination of implant choice, surgical technique, and unfavorable anatomy. 

When a patient starts out with a wide space between their breasts it is important to inform them that this is an anatomic variation which is only partially correctable, and that they will still have a somewhat wider space after augmentation, although it should be improved. However, if the choice of implant and surgical technique are not appropriate to the situation, the problem can actually be accentuated. Your implant has displaced downwards and outwards making your breast look somewhat bottomed out and exaggerating the wide space. In this type of setting a smooth surface higher profile implant is much more predisposed to this type of malposition. It is a misconception to think that a higher profile implant will create more cleavage, often it is just the opposite.

Correcting this, and improving cleavage, would involve switching to a lower profile (wider diameter) implant of similar or slightly larger size and modifying the implant pocket internally with sutures by doing an internal capsulorraphy to tighten the pocket on the out side and underneath. This will reposition the implant higher and more medial thus creating improved "cleavage". It is important not to overdo this repositioning because it can cause your nipple to be rotated outwards which looks weird. In this type setting I would recommend using a textured surface implant. Textured surface implants adhere to your tissues and therefore are much less likely to displace over time. Mentor implants do not have an aggressive enough texturing to consistently adhere. I would recommend using a Sientra implant. 

The bottom line is that your situation can be improved but will require a more thoughtful choice of implant and very precise surgical technique to correct the problem

Cleavage

Yes, a skilled and artistic surgeon will have no trouble creating a much narrower cleavage area, but that look is strictly limited by your anatomy and will probably never be as close as you want, just markedly better than the current look. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Cleavage

It looks to me like your implants are not wide enough for your breast.  I think wider implants might help out a lot. There are some other possibilities, but that I think is the main issue.

I am attaching a link to an example of a case where wider implants helped the aesthetics a lot, IMO.

Good Luck!

Michael E. Decherd, MD
San Antonio Plastic Surgeon
4.9 out of 5 stars 52 reviews

Better cleavage

 From your photographs, I think that with a wider implants that's not so tall such as an oval based Sientra shaped implant both the bottomed out appearance and wide space between the breasts can be made better. In my mind, you need a capsulorraphy at the bottom and on the side, along with a wider base width implant to accomplish your goals. Try to find a board-certified plastic surgeon in your region with experience in cosmetic breast surgery revision. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

No you are not stuck

I think that with the appropriate implant selection and proper surgery, you will have a significant improvement.  I would encourage you toe seek a surgeon who will help you get the results you want.
Best Wishes,
Nana Mizuguchi, MD

Nana N. Mizuguchi, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 45 reviews

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.