It’s not unusual for patients to have specific aesthetic goals for size, contour, and cleavage following breast augmentation surgery. Unfortunately these aesthetic goals aren’t always easily accomplished and for this reason comprises may occasionally be necessary. This is frequently the case when patients are concerned about cleavage following surgery.Poor cleavage can occur for a variety of reasons. In the majority of cases, inadequate cleavage is related to anatomic considerations. These include abnormalities of the chest wall, abnormalities of breast contour, and abnormalities of nipple areola position.Unfortunately your pictures suggest significant lateral malposition of your nipple areola complexes. This places limitations on the amount of cleavage that can be obtained with breast augmentation surgery.Increasing the size of the breast implant probably won’t significantly alter cleavage for several reasons. It’s important to center the implant directly beneath the nipple areola complex. In an effort to improve cleavage, implants with wider base dimensions are occasionally used. When these implants are centered beneath the nipple areola they move the breast laterally and medially. When patients have laterally positioned nipple areolas, this results in the breasts protruding in an outward direction to the side.Efforts to create cleavage by moving the entire implant is an inward direction can result in malposition of the nipple areola complex. In these cases, the nipple areola would look as if it were sitting the side of the breasts.Increased breast implant size may not always be the solution for poor cleavage. If you’re considering breast augmentation and cleavage is one of your primary aesthetic goals, it’s important to discuss this issue with your plastic surgeon. Your surgeon should be able to perform a physical examination and discuss any limitations that might be imposed by your unique anatomy.