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.
Gary Horndeski, M.D.
You can certainly obtain closer cleavage by creating an internal pocket that moves your implants more medially. However, this will also mean that your nipple and areolar complex are less centered. Another option would be a wider, larger implant, which would improve your cleavage without the distortion of the nipple and areaola complex and with less downtime.
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.
Better opt for extra high profile retroglandular placed high cohesive textured silicone gel implants 400-450ml and the possibility of getting what you want is high.
I concur thaqt your present result is very good to excellent. You will not be able to attain cleavage with larger implants that look natural whether they are placed submuscular or subglandular. Remember that the implant is centered ubder the nipple, and larger implants that are positioned closer to each other could result in an abnormal nipple location.
I wish you well !
The amount of cleavage you have after surgery is largely dependent on the degree of cleavage you have before. Implants placed under the muscle are limited in how far towards the middle they can be placed but even more importantly the breast implant should be centered on your nipple. In your consultation with your board-certified plastic surgeon these issues should be addressed for proper expectations from your surgical result.
I hope this helps
The result posted is excellent. Your chest wall anatomy precludes attaining nude close cleavage, sorry to say. Do not think any surgery can help attain your desire..
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
Your implants do sit a little more laterally than ideal, but also you need to accept your starting point and what limitations it places on potential results you can get. The first thing to consider is that wider implants with pocket opening medially can improve cleavage. It is more dependent on implant width than on the profile to determine the closeness in the middle. Also, your pockets might need to be closed off laterally which can only be determined on exam.