Breast implants should be centered on the nipple-areolar complex. If they are placed too far to the center, the breasts will appear off-center.
Simply placing larger implants creates problems as well. The muscle in the center of the chest on the breastbone (sternum) must be detached in many patients to allow the implants to go more to the center. This can cause the chest muscle (pectoralis) to contract in an unusual fashion. It is also irreversible.
We advise our patients not to go too large with their breast implants.
Patients who have very large implants are at much higher risk for needing multiple redo surgeries, for having rapid sagging of the breasts, and stretch marks.
While the issue of ‘over’ or ‘under’ the pectoralis major muscle receives a great deal of attention, even more important than implant position relative to this muscle is implant position vertically and horizontally on the chest wall. In many patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola, and in order to prevent the appearance of excessive upper pole fullness.
In profile, the natural-appearing breast is not convex in the upper pole, and an excessively convex and overly full upper pole is a dead giveaway that an implant sits below the skin. Likewise, if the inframammary fold is lowered too far, the augmented breast will appear ‘bottomed out’, with an excessively full lower pole, an empty upper pole, and a nipple/areola that appears to sit too high on the breast – another situation with a distinctly unnatural appearance.
The horizontal position of breast implants also requires a great deal of attention, both in pre-operative planning and in the operating room. Breast implant pockets that extend too fat laterally will result in augmented breasts with an excessively wide space between them in the cleavage area, and the appearance that the breasts are abnormally far apart. If the pockets do not extend far enough laterally, however, the result is an augmentation with an abnormal ‘side by side’ appearance. As it is the lateral projection of the breasts beyond the lateral limit of the chest wall (in frontal view) that, along with the concavity of the waist profile and the convexity of the hip profile, produces the appearance of an ‘hourglass figure’, careful attention must be paid to ensure that lateral breast projection is adequate and appropriate.
Another consideration is that the implant base diameter must match the existing anatomic limits of the breast preoperatively and the breadth of the anterior chest in general. Obviously, a given implant volume and diameter that works well for a small-framed patient who is 5’2” will be inadequate for a large-framed patient who is 5’10”. Careful evaluation of all of these issues is necessary if the ultimate goal of the surgery is a natural-appearing breast enhancement.
Michael Law MD
Board certified Plastic Surgeon
Raleigh, North Carolina
Web reference:
http://www.michaellawmd.com
Your baseline cleavage, or inversely, the degree of breast separation, is a major determinant to the degree of cleavage achievable postoperatively. The surgeon can dissect closer to the midline but must be cognizant of overly thinning the tissues and potentially creating symmastia ("unibreast"), a very difficult problem to correct.
Your hi-profile implants are the narrowest of the three profiles (hi, moderate plus and moderate), therefore less likely to yield cleavage. Yes, you could consider revision with more dissection toward the midline and placement of a wider- based implant.
You should discuss your concerns with your surgeon.
The amount of cleavage obtained after breast augmentation is primarily determined by these three factors:
- Volume of implant
- Base diameter of the implant (how wide the implants are)
- Position of the nipple relative to the middle of your chest
- Subglandular or submuscular placement of implants.
Plastic surgeons can do little to change the distance of the nipple from the midline of your chest. During a breast augmentation, the implant is placed in a pocket that lies below the nipple. If the nipple is positioned very far to the sides, the implants will be positioned laterally, thus resulting in less cleavage. The wider the implant that is placed, the better the cleavage.
There are limits to how wide of an implant we can place as the wider we go, the more implant there will be on the sides of your chest.
Its important to measure these distances before you undergo breast augmentation. Discuss the position of your nipples and the placement of the implants. An experienced plastic surgeon can usually predict the amount of cleavage you will obtain based on these numbers. The more you discuss before surgery, the better.
In general, you can get more definitive cleavage with implants placed on top of the chest muscles. This is somewhat dependent on what amount and distribution of natural breast a person has to begin with. With the size of your breast you describe, any cleavage in you would come form the size and type of implant.However, you shouldbe aware that breast augmentation is an imperfect operation and you have to be able to accept certain imperfections, otherwise you can end up chasing the imperfections.
While you might be able to increase cleavage with wider implants or by releasing the muscles more aggressively near the sternum, both can have detimental effects. These effects should be fully discussed wth your plastic surgeon. In general, the more you go outside the natural dimensions of your native breasts, the more side effects and long-term complication you might have with rippling, palpability, tissue atrophy, asymmetry, and displacement of the implants. Sometimes, it is better to accept the limitations of your natural anatomy.
When placing implants underneath the muscle, your surgeon must take great care to dissect the muscle properly to create the right cleavage. If the muscle is not released adequately, you will end up with a very wide space in between the breasts. If it is released too much, you can end up with synmastia, or a "uniboob" as some patients may call it.
To correct the wide space, you may want to consider a slightly larger implant, with a wider base. Your surgeon could increase the release area in the cleavage to improve the appearance. If the breast is really hanging low, the surgeon may recommend a mastopexy or lift procedure to correct the overall shape. This may require an additional incision around the areola or a larger incision on the base of the breast.
Either option may help you look more perky in your frame.
The only way to get the implants to look closer in the midline is to use ones that are wider than what you have. You might want to consider this in addition to maybe going down to a moderate plus profile so your breasts don't end up looking unnaturally large.
There are a couple of things to consider in order to get the cleavage right:
- Most important I think is base diameter, so that there is the optimal space between the breasts while centering the implants in the natural foundation of the breast. With the right implant dimensions, some improvement can be acheived while still keeping the implants under the muscle.
- The other issue is cohesive implants, which are shaped rather than round, and firmer than other silicone implants (which are also "cohesive" but softer). Because the round implants are not as stiff, they will move together more with pushup bras and bikini tops.
Thank you for your question. A patients pre-operative anatomy and intramammary distance will largely dictate the amount of cleavage that a patient can reasonably expect to achieve post-op. Breast implants are placed with the nipple-aerolar complex as the center point. If placed, using any other landmark as the center point, a patient's implants will appear off-centered and unnatural. Some patients, like yourself, will ask whether a larger diameter or wider implant would help to achieve more cleavage if they have wide set breasts, but I believe that in most cases this is a mistake unless a patients anatomy deems that diameter implant appropriate. Placing too wide of an implant can cause symmastia, or a 'uniboob,' and is a post-op complication that is very difficult to successfully correct.
Unfortunately, you cannot successfully change the height of a patients breast or the width of a patients breast or where the breast sits on a patients chest with a breast implant. While sometimes implants will help to make things appear closer together or lifted, this is not always the reality and should be thoroughly discussed pre-operatively and at the time of a consultation.
I would recommend following up with your operating surgeon to discuss your concerns and any options that may be available to you. Best of luck!
The vast
majority of patients who undergo breast augmentation consider cleavage to be an
important component of an aesthetically attractive breast.Unfortunately, patients sometimes present
with anatomic constraints that limit how much cleavage can be obtained with
this procedure.When patients have
laterally sloping chest walls and laterally positioned nipple areolar
complexes, cleavage isn’t always possible.Efforts to create cleavage by moving implants in an unusual direction
can often result in secondary deformities.
Without pictures or a physical
examination, it’s virtually impossible to make a specific recommendation in
your case.For these reasons, efforts to
move your implants in a medial direction or efforts to increase the size of
your implants with additional surgery aren’t indicated and could have negative
consequences.It’s important to discuss
these issues with your plastic surgeon.Your surgeon should be able to address your concerns.
