I want the cleavage look when my breasts are naked. What is the best implant to obtain this? (photos)

The first thing to consider is that the implant base diameter needs to be wide enough, so high profile is the least likely to do that because they add projection more than width. The second factor is that implants under the muscle cannot move any closer than the muscle attachment will allow. Trying to get them too close together risks symmastia. Going over the muscle would allow them to come closer together but you would lose coverage and possibly see rippling. Sometimes an internal bra procedure using Strattice, SERI scaffold mesh, or Gala FLEX mesh can help hold the implants up and in.

Since 375 cc implants did not give you the cleavage you desired, it is unlikely that 475 cc implants will.  Implants only add volume, however, you are trying to change the shape and position.  I recommend a new technique called Breast Augmentation with Mini Ultimate Breast Lift(TM).  Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall maximizes anterior projection with a minimal size implant.  Small round textured silicone gel implants placed retro-pectoral look and feel more natural, are more stable, less likely to ripple or have complications needing revision.  Implant profile is irrelevant in the retro-pectoral position since the muscle compresses it.  Using this technique it is possible to achieve the cleavage you desire using smaller implants which are stable and eliminates the side boob which is undesirable.  22% of women who undergo breast augmentation alone require revision within 2 years because they are dissatisfied with the result.  Repeating implantation will not solve your problem.Best Wishes,Gary Horndeski, M.D. 

Thank you for the question and photos. You have a good result considering your anatomy. The implants sit on the chest wall, and if your rib cage slopes down laterally (in your preop photo the breasts are situated laterally) the implants will do the same. The implants just magnify this fact. In your postop photo, the slight depression of the lower breast bone is again magnified by the augmentation. Personally, going to larger implants would be a mistake. I would close down the lateral implant pockets and also fat graft the medial breasts and cleavage area. See a  board certified plastic surgeon familiar with fat transfer to the breasts and has good consistent results. Good luck.

Many patients would like increased cleavage, which can improve the look of your breasts in clothes and while nude. Cleavage can be enhanced by larger breast implants and revision of the tissue capsule internally. Raffy Karamanoukian MD FACs

I agree with Dr. Pousti, but would like to add that it is not simply the type of implant that is used that gives the results you want. Preoperatively your breast photos show that your nipple areola complex (NAC) are lateral on your breasts.  If implants are placed to give more cleavage, then your nipples would be even more exaggerated laterally.  Typically implants are placed centered directly behind the NAC to give a symmetric shape with the NAC in the middle of the breast mound (it appears that your post operative photos show that).  Going with a larger implant will certainly give you more cleavage, particularly an implant with a larger base diameter than what you currently have.  Just keep in mind that you may end up with more "side boob" too. A capsulorraphy will help by limiting the amount of "side boob".  Be sure to discuss your desires with a BCPS who has a lot of experience with this.  Good luck!