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

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.

Hello,
Thank you for your question, selection of the correct implants and whether the implants are placed above or below the muscle are the main ways that breast cleavage is dealt with. Changes in nipple to crease distance is done with a breast lift.
Thank you
Dr. Jame J. Chao 

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