Could I achieve really good cleavage with sub muscular implants? (photo)

It looks like you would probably need a lift along with augmentation. This would prevent a “rocks in socks” look. The lift would reshape your breasts to give them a less flattened out look and enhance fullness in the upper portion. The implants would then give you more volume. While the procedure may help improve your cleavage to a certain extent, your breasts are naturally set far apart so they’ll most likely remain this way after your surgery as well. 

Thanks for your inquiry and pictures.  I believe with a highly experienced plastic surgeon performing both a lift and augmentation--you can get good cleavage.  Please seek an in person consultation and good luck.  

The presence of wide set breasts is not a contraindication to surgery. Patients, however, must understand the limits of the surgery. Implants will not create cleavage in the sense that they cannot medialize wide or lateral set breasts. The implants will be centered on your native breast mound which may seemingly worsen the wide set nature of the breasts without actually changing the measurements. It is often helpful to think of breast augmentation as a magnifying glass or IMAX screen where all aspects of the breast are enlarged (+) and (-).
One option for creating a more central or medial mound is subglandular augmentation. In this scenario, the medial boundary as defined by the pectoralis muscle attachments to the sternum are not present. This can allow for greater medial dissection and by association greater cleavage (not recommended). However, this does in crease the risk of symmastia. There is also the risk of deformity which stems from failure to center the implant on the native breast mound.
Based on your photos, you have wide set breasts. Subglandular augmentation can (potentially) allow for more central implant placement. However, it is important to remember, anatomy trumps all. Thus there is a limit to how centrally implants can be placed without disturbing the alignment of implant and native breast.In my practice, I would recommend submuscular augmentation and a mastopexy (as you exhibit Grade 2/3 ptosis).
As always, discuss your concerns with a board certified plastic surgeon (ABPS).