Sub Glandular Vs Sub Muscular Implant for Better Cleavage?

I recently posted a question whether to get sub muscular or sub glandular implants and the feedback was most helpful in my decision. I'm leaning toward sub muscular 300cc silicone because I believe this will fill out where I am flat in my upper chest while looking most natural. My question is will this size and placement be enough to give me more cleavage? I've read that submuscular placement gives the chest a wider cleavage and I want to fill my breasts out and achieve more cleavage, not wider.

Doctor Answers 16

What "is" cleavage?

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In the past year, many of my patients have been calling "cleavage" the roundness in the upper pole of the breast, similar to what a push up bra does.  Most of us who are older (and since Board Certification take so long, Plastic Surgeons who are Board Certified are a bit older) consider cleavage to be what is between 3 oclock and 9 oclock of your breasts.  So we first need to know the right definitions.  You speak of wanting your breasts to "fill out, not be wider".

If it is the roundness that you wish in the upper pole,  then a higher projection device would help with that.  Technically, being on top of the muscle would help with that even more, but the complication rate is higher as well.  Because of the higher rate of capsular contraction, and the possible difficulty in seeing the beast tissue as easily on mamography when the implant is on top of the muscle, I am not a big fan of on top of the muscle approach.  At the end of the day, we would like to cut down on complications, and reoperations, as these really decrease the satisfation rate of patients with their overall experience.  So if it is roundness in the upper pole that you wish, go for a higher profile implant.

On the other hand, if you wish to have less space between your breasts (traditionally thought to be "cleavage"), you would get less space between with a lower profile implant, like the "moderate" profile silicone.  Silicone implants can be much wider than saline in diameter. 

Your pictures show that you have a bit of pectus carinatum or "pigeon chest", which tends to push the implants out to the side.  This is just your foundation, and we cant change that (without breaking your ribs and sternum).  So physics says that your breasts will go out to the side more than someone who has a chect that is pushed in at the sternum (pectus excavatum).  We cant get water to run uphill.  And gravity and the push of your pectoral muscle will be to push your implants slightly more to the side over time.

So you have many factors involved, and you have to make the choices knowing that their are pros and cons with whatever your decision might be.  Go to your Board Certified Plastic Surgeon who is a member of the American Society for Aesthetic Plastic Surgery (ASAPS) and have a consultation to go over all of these complex variables.  An ASAPS memeber does the majority of his Plastic Surgery in Aesthetic (Cosmetic) Plastic Surgery.  Good luck in getting your new wonderful look!



Orange County Plastic Surgeon
4.8 out of 5 stars 35 reviews

Does Implant Pocket Placement Determine Cleavage?

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Thank you for this excellent question.  The amount of cleavage you get and how to achieve more cleavage requires a multi-factoral answer.  First of all, if you have plenty of cleavage now, then it really doesn't matter which pocket you put the implant in.  You won't loose that cleavage.  Secondly, your existing cleavage is directly related to where you pectoralis muscle inserts on your sternum.  If it inserts close, you have more cleavage.  If there is a wide separation between the right and left pec, then you have a wide cleavage.  Depending on the width of your chest, placement of your nipples, and depending of which profile of implant you choose (moderate plus or high profile), the wider the implant in general, the greater the cleavage.  Implants below the muscle stay softer and look better.  Implants above the muscle give you a chance of increasing your cleavage but at what cost. 
Wow, TMI.  As you can see, so many questions to answer.  Of course, the right answer here is to pick an excellent, experienced Board Certified plastic surgeon, and then allow him or her to do all the heavy work (the stuff above). 

Sub muscular vs Sub Glandular placement

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Submuscular placement may be more uncomfortable the first few days following surgery. The possible benefits of submuscular placement are that it may result in less palpable implants, less capsular contracture, and it will make it easier to image the breast with mammography. The appearance may be more “natural” for patients who are very thin. Subglandular placement may make your surgery andrecovery shorter and you may have less discomfort. This placement may provide a slight “lift”. Subglandular placement may result in more palpable implants, more capsular contracture and more difficult imaging of the breast with mammography. This placement is often recommended for those patients with sagging, but do not want a breast lift (mastopexy) and for tubular breast deformity

Cleavage depends on your natural breast positioning

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Post-operative cleavage will depend on your pre-surgery cleavage. You have wide-set breasts, which means you'll probably continue to have wide-set breasts after surgery. However, while you may have a bit of improvement, it may not be as much as you want. Unfortunately, your surgeon can only do so much to give you cleavage before it looks abnormal, since the implants have to remain centred underneath your nipples.  

Sub Glandular Vs Sub Muscular Implant for Better Cleavage

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Each surgeon has his or her preferences based on experience and expertise. Subglandular placement will typically allow for more cleavage as it will provide increased implant visibility. However, patient selection is key and most patients will receive beautiful natural looking results with submuscular. Consult with 3 board certified plastic surgeons to understand your options, and choose the surgical plan/surgeon that best fits your goals/objectives.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

Submuscular breast implants will provide better cleavage

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There are many advantages to having your breast implants placed in a submuscular(subpectoral) position. It is easier to perform mammograms, there is a higher likelihood of breastfeeding and a lower incidence of capsular contracture (scar tissue). Also, your cleavage will look more natural with implants under the muscle.

Best wishes,


William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 412 reviews


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Implant placement (over or under the muscle) has nothing to do with cleavage because the implant sits behind your breast, so that whatever cleavage (the distance between the breasts) you have now will be the same post surgery.  If you want to create more of a cleavage then you need good push up bras.  As for over vs under muscle implant placement, I prefer under the muscle.

Andre Aboolian, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 63 reviews

Subglandular placement of breast implants

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Placing implants submuscularly can provide you with fullness and cleavage. There are limits as to how much cleavage you can create without causing problems but in my opinion, under the muscle is the better choice.   It is difficult to determine implant size and implant profile pre-operatively. Every surgeon utilizes a different technique to determine implant size. It is too much responsibility for the patient to decide on which type of implant should be used. After communicating with the patient, I use sizers intra-operatively to decide which implant profile and size to use to achieve the patient’s overall goals.

Breast Implants Placement

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There are a number of compelling reasons for selecting subpectoral placement over submammary placement. The most significant is that fact that radiologists have indicated that it is easier to image breast tissue by means of mammography when the implant is subpectoral. The pec major also provides an additional layer of tissue to conceal breast implants in the 'social aspect' of the breasts - that part that is easily visible in swimsuits and lower-cut clothing. Additionally, the pec major is quite effective at flattening the upper pole of a breast implant so that a natural slope for the upper aspect of the breast is created.

Implants placed on top of the pec major tend to look very convex in the upper pole. The breast begins quite 'abruptly' in the upper aspect of the chest, and the appearance is therefore distinctly unnatural. Submammary implants are also more likely to have visible implant folds and ripples in the cleavage area. Another consideration is the fact that there is some evidence which suggests that the risk of capsular contracture may be lower with subpectoral implant placement. Even if the risk of contracture is the same, a mild contracture tends to be less noticeable and therefore less of a problem for the patient when the implants are in a subpectoral position.

Submammary placement may produce a reasonable result for fuller figured patients with larger starting breast volumes, as the larger amount of natural subcutaneous fat and breast tissue helps to conceal the implant contours. The problem is that as breasts age, they tend to deflate - especially in the upper pole. So what was adequate implant coverage in the cleavage area at age 27 may be inadequate coverage at age 37, and implant folds and ripples gradually become visible. So subpectoral placement is the best choice for both the short and long term.


Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews


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Cleavage is more dependent on the bra and the shape of the chest rather than the implant position. . In this picture the sternum is more anterior than the ribs and the ribs flat surface is pointing away from the mid line so the implants will tend to be more lateral leaning and not medial leaning. The bra will make a bigger difference in the cleavage here.  

Walter D. Gracia, MD
Fort Worth Plastic Surgeon
4.7 out of 5 stars 3 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.