What strategies do you as surgeons use to create cleavage/bring breasts closer together?

Hello and thank you for your question and sharing your photos. Cleavage after breast augmentation, to a large extent, depends on the existing cleavage pre op. Having said that, careful dissection of the implant pocket, and proper selection of the implants are some of the other factors that play a role in creating a natural cleavage. Hybrid breast augmentation, with a combination of fat transfer using your own fat and implant-placement is a power technique that can improve the cleavage in breast augmentation is patients with a wide cleavage pre op. I would seek consultation with a board-certified plastic
surgeon for a full evaluation and advice. Best,
Pejman Aflaki, M.D.                                            
Johns
Hopkins-trained double board-certified plastic surgeon

Thank you for sharing your question.  Much of a patient's final results depends more on their starting anatomy than what can be accomplished during the procedure.  In select cases the way a muscle is divided, and breast tissue scored, can improve a patient's breast shape and position on the chest.  Too much manipulation, or attempts at improving cleavage, can backfire however and cause complications that are difficult to correct.  Talk to you surgeon about your concerns, they can offer you the best advice. 

In primary breast augmentation, the pocket can be dissected with space in the upper pole and parasternal area with limiting the lateral dissection to hold the implant more centrally.  In secondary breast augmentation. the pocket can be adjusted with sutures or a biologic such as Strattice to hold the implant more medially.

Cleavage is the result of the width of one's chest bone. You cannot bring the breasts over it or you will risk symmastia (joined breasts). However, cleavage can be reduced to some extent by placing a larger implant with wider diameter, fat grafting or artificially creating it with a push up bra! Women sometimes like to show some cleavage in an evening gown or low cut neck T-shirt. If you have a wide chest bone and cannot have a narrow cleavage, then this is the safest way that I recommend to my patients after the optimal augmentation and respecting the anatomical boundaries.Best of luck and be safe!

Unfortunately, you have not provided photographs or told us your bra size.  However, there are 2 ways to change breast position on the chest wall.  One is a modification of the Benelli technique, which uses a circumareola incision.  It is possible to reshape the breast tissue, elevate them higher on the chest wall and more medial to increase your cleavage.  The other is for more ptotic breasts called The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.  These procedures do not change breast volume.  If you want additional volume then you can place small implants or fat transfers.  Implants are not lifetime devices.  8% fail within the first year and 30% fail within six years.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

The not so short answer to your question is that there are many considerations in breast augmentation that will influence the final outcome. These include, as you correctly pointed out, the patient's existing anatomy, the surgical option, the way in which the operation is performed, the type of implant used, the implant position (sub pectoral or sub muscular, dual plane, subfascial, sub glandular) and terminology. Breasts cannot really be "brought closer together", but cleavage can be enhanced. If the goal is a greater degree of cleavage, which usually means more fullness on the inner breast, this can be accomplished surgically with some of the choices mentioned above. The way to make the nipples APPEAR closer together relates to the way the implants are positioned within the breast in relation to the nipple. To ACTUALLY bring the nipples closer together would require a repositioning procedure which would be  a type of breast lift or mastopexy.It is best for you to consult with an experienced board certified plastic surgeon(s) who can evaluate you in person and address all of your questions. Best of luck to you. 

Dear Jubilant2138,
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. 
If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello, thank you for your question. The space between your breasts is determined by your breast tissue, muscles, and breast bone. There is a limit to how close breast implants can or should be placed in order to have an overall good result. Your breast cleavage can improve with breast augmentation, implants will give you more volume.

In general cleavage cannot be built. The good news is that increased breast volume makes it easier to create cleavage in clothes. More volume can be created with implants than fat transfer. A surgeon dissecting beyond the natural limit of one's anatomy to "build" cleavage could possibly create a symmastia or uniboob.
Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author    RealSelf Distinguished Hall of Fame Inductee

Changing the nipple location is done with a lift. Anatomy does limit how close together breasts can be, but an augmentation with bring the breasts closer together. The dissection of the pocket or space for the implant can also be changed to help maintain a closer position for the beasts.