Can I achieve a better cleavage although I have an asymmetric bone structure? Using same scar? (Photos)

I've had a BA already(255ml round sientra sub-muscular). I am not happy with the result since I really wanted cleavage-not side boob.My question is if it is possible to bring the implants closer together,maybe choose wider implants but still want the natural look. Also my chest muscles are quite strong & i was wondering if they can be detached more (especially my right breast has an abnormal shape). Is all that possible using the same scar (directly under my nipple)? Thank you so much in advance

Doctor Answers 10

Better Cleavage?

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Sorry to hear that outcome is not what you had anticipated. Your situation is an example of how a not well considered choice of implant can actually accentuate a pre-existing chest wall deformity. It looks like you likely have a high profile implant which is properly centered behind your nipple. Part of the problem for you is that breast and nipple position are located more lateral on your chest wall. In order to achieve an aesthetic breast shape the implant needs to be centered behind your nipple, but that means in your case the implant will be located more lateral on your chest wall thus creating more "side boob" and less cleavage. I believe that a more appropriate implant profile would be a lower or moderate profile implant, possible slightly larger volume. An implant such as this will give you a bit more side boob, but it will also provide noticeably better cleavage which is really what you notice to be missing.

Along with changing implants it would be useful to do a very careful release of tissue and/or muscle attachment along the inferior/medial aspect of your breast to enhance cleavage and improve the overall shape of your breast. This must be done cautiously so as to avoid a visible edge of the implant or the worse situation of synmastia. Yes you can use the same incision, but the peri-areolar incision is associated with a higher incidence of capsular contracture. In addition repeat procedures through that incision can result in an unattractive scar retraction along the border of your areola.

I think the Sientra implants are an excellent choice. They contain a very cohesive gel which at the same time has a nice soft feel and appearance. There are somewhat more cohesive gel implants on the market such as the Natrelle 410, but they are excessively firm and I have seen several patients who wished to have them removed because of the overly firm feel and rigid appearance. It was a surgeon in California who coined the term "Gummy bear" when they were first introduced to the Allergan 410 implant. If you have had occasion to feel a piece of gummy bear candy lately, you would notice that they actually have a very firm consistency. Hence the name for this overly firm implant. This would be a particularly important consideration in a patient such as yourself with thin tissues.  One additional thought is that you might consider a textured surface implant if you don't have that already. Textured surface implants will adhere to your tissues and thus will be less prone to move out of position over time. Because your breast is located more lateral on your chest wall your implants will be predisposed to dropping out towards your armpit over time. A textured surface implant will be less likely to migrate in this direction. Some people will argue that an implant that doesn't move around easily is not like a natural breast. That may be true, but I would bet that your "natural" breast before surgery did not move around all that much, and having an implant in your armpit might be natural, but most women are not found of that look.

How to improve better cleavage.

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Because you are lean, and have a somewhat boney chest and rib cage, you could have a better cleavage with  a larger implant. It appears that your surgeon placed the implants properly, because they have to be centered behind the nipple. But a somewhat larger implant will give you a better cleavage appearance.

Malcolm A. Lesavoy, MD
Beverly Hills Plastic Surgeon
3.9 out of 5 stars 11 reviews

Breasts augmentation cleavage

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Dear Julie,

   Thanks for submitting your pictures and sorry for your disappointing result. From observing your before and after pictures, it appears that you were 34 small A cup size and now you are 34 B cup size with very wide and unattractive cleavage.

   It is quite easy to achieve your desired goal of nice cleavage and covering the bony areas. However, it has to be performed by an experienced plastic surgeon who is comfortable with dissection of the muscles  close to the midline. Also, I would recommend to increase the size of your breasts to 34 full C cup size, which means 450 cc implants. Such large silicone implants will require different entry incision - infra mammary, which is not a good idea , if you want a nice cleavage (it is too far from the cleavage area). So , convert you implants to saline implants, as I have used them almost exclusively for over 29 years on thousands of delighted patients.

    Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.

                    Best of luck,

                                         Dr Widder

Breast Augmentation Results

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One could argue that your surgeon sized and placed these implants perfectly, even though the results are not what you were hoping. As others have mentioned, larger implants may positively impact gap width, possibly at the cost of implant visibility (rippling). Careful release of the medial portion of your inframammary fold, which may include more muscle release, and placement of a wider implant (but not more projecting - that accentuates the gap), you will have a noticeable improvement. My recommendation for women like you is to really get the best implant possible for the job, which is a form stable, highly cohesive gel implant . Although many doctors call Sientra implants 'gummy bears' (which has been passed along to the general consumer erroneously), they are barely more cohesive than Mentor's or Natrelle's round smooth implants. There are really only two highly cohesive implants that should be considered form stable or 'gummy bear', the Mentor Memory Shape and the Natrelle 410. In addition to pocket modification and a wider device, fat grafting can help with your very lean sternal region. This may be difficult given your lean body, however. Have this discussion with your doctor. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Can I achieve a better cleavage although I have an asymmetric bone structure?

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It appears that you are recovering from recent surgery looking at your incision lines which should fade in time.  Going to a larger mid-profile implant will increase the diameter of each implant partially benefiting your cleavage.  The larger the implant and the wider the implant the greater the tendency for the implants to also drift outward due to gravity and the natural shape of your rib cage.  I do think however a larger implant would be worthwhile as long as you do not go to excess and that your expectations are realistic.  I always look at the natural shape and width of the cleavage and remind patients that bra support may be an essential need to maximize your cleavage benefit with fuller breasts from placement of breast implants.  

The video link above also addresses the issue of cleavage.  Good luck and best wishes.

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 33 reviews

Better cleavage w/asymmetric bone structure, using same scar?

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Thank you for your question. Many patients have thoracic asymmetries. Implants can help to disguise these areas if they are of an appropriate size to cover the area of concern. Your present implants are well-positioned, and centered appropriately on your natural nipple-areolar position. A wider implant (larger volume) would give better coverage and provide improved cleavage definition. Obviously, this will also potentially increase your cup size as well. The same incision could be used again, and any required muscle release could also be performed at the same procedure. I hope that this information is helpful.

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 20 reviews

Can I achieve a better cleavage

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Thanks for including such good photos with your question. It is easy to see what you want and achievable to some degree. When we place implants they must be centered with the implant center behjind the nipple, assuming there is no droop. Your surgeon did a very nice job with that, but because the implants are small they don't get enough volume towards the breast bone. So wider implants would do the job, but that means for they will also go further to the side. If you simply move the implants you now have over toward the breastbone it moves them out from under the nipple and will leave the nipple sitting on the side of the implant. That would be a look you would find far worse than the current well positioned but too small of an implant. Choose your surgeon both for experience and also artistry. BTW, yes...the same incision can be reused. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Improving Cleavage with Breast Revision

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Thank you for your question about how to create better cleavage.  For patients with a wide breastbone or naturally separated breasts, care must be used to gain enhanced cleavage.  A combination of careful pocket modification and wider implants can give improvement.  Care must be taken to not create a "double-bubble" deformity when implants extend beyond the breast tissue envelope, so please choose your surgeon carefully and understand the techniques to be utilized.   Best wishes!

Stephen Bresnick, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 34 reviews

Can I achieve better cleavage?

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Thank you for the question and pictures. Yes, it is likely that revisionary breast surgery, involving careful dissection of breast implant pockets and selection of wider/larger breast implants would achieve an outcome that you would be happier with.  The same infra areolar incisions can be utilized for this type of revisionary breast surgery.

Some general thoughts regarding "cleavage concerns" may be helpful to you and other young ladies considering breast surgery:

Patients undergoing breast augmentation should understand that their anatomical “starting point” will play a significant "role" in the outcome that they can expect with breast augmentation surgery.   If the patient starts out with a significant distance between the breasts, there are limits as to how close of "cleavage" can be achieved.  If over dissection (when developing breast implant pocket) occurs in the cleavage area, with the goal being to achieve as close as possible cleavage per patient's request, patients may experience significant problems such as breast implant displacement (medial  malposition or symmastia) and/or significant breast implant rippling/palpability.  Obviously, these types of problems may require revisionary breast surgery to correct.  

Also, keep in mind, that each nipple/areola complex must remain centered on each breast mound after surgery.  Again, careful dissection of the breast implant pocket and appropriate selection of breast implant size/width/profile will also play a role when it comes to how close the cleavage area will be postoperatively (and the overall shape/symmetry of the breasts). Careful measurement/dimensional planning plays a big role in this regard.

 I hope this, and the attached link, helps. Best wishes.


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The same incision can be used to try to release the right muscle a little more. However, due to your anatomy, you may not be able to achieve a more narrow look with implants placed behind the muscle. Your doctor, who has examined you, can give you the best opinion about your anatomy.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.8 out of 5 stars 18 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.