No cleavage or upper pole fullness after breast augmentation

Question

I am now 7 months post op and am not happy with my results. I had almost no breast tissue before surgery and went with 425cc high profile silicone implants. However, I have no upper pole fullness or any middle fullness. I wanted to be able to wear low cut shirts/dresses that you can't wear a bra with and have some type of cleavage, however I have none. Without a bra I still look pretty much flat in low cut clothing. Would upsizing another 200 Cc's help any?

Gerald Minniti, MD, FACS · Answer

Hello,I'm going to be very honest with you. As you said, you started with nothing. You got relatively large implants for you anatomic capacity as evidenced by your stretch marks, indicating substantial expansion. Your results are frankly very good. You actually do have upper pole fullness.  Your gap is appropriate for you anatomy, and is not excessively wide. The person whose look you wanted has two balls on her chest; she looks like she has capsular contracture around both implants.  This is not what most surgeons or patients strive for. If you really want that look, you can probably get it, and you're right, more volume is the key to this ballish look. I would also probably get Natrelle's Inspira silicone gel implants too, as they are designed to have more of that saline/ball look. Be careful what you wish for. You are already stretched thin, and you will be even more so after larger implants. You are at high risk for rippling and other contour deformities, as well as malposition issues, either early or late.Best of luck!

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question.  First, you have an excellent result. That being said, you will likely need larger, possibly more projecting, implants to achieve the result that you desire. Pocket adjustment will also probably be needed to get your implants up and in. Caution should be taken with large implants in a petite frame as they can cause often uncorrectable problems.   The important determinants are your breast width as well as your tissue laxity. Best wishes!

Christian Subbio, MD · Answer

For what its worth, you have a very beautiful result, good shape, position, etc, and it looks like your surgeon did a very nice job.  Unfortunately, cleavage is a very tricky thing.  It is very much dependent upon the pre-existing anatomy of any given patient.  Some women's pectoral muscles are placed more centrally, some are splayed more widely.  This can limit the pocket dissection and how centrally one can place the implants.  As well, some women's starting out with more breast tissue on the inside of their breasts.  When the implant is placed, this allows them to be pushed more centrally and appear closer together, with better cleavage.  Same with upper pole fullness.It is tempting to consider adding more volume, and this may get you closer to the look you are looking for.  But, there are consequences.  425 is already a generous sized implant in a woman with a smaller frame like yourself.  A 625 cc implant may give you more of the fullness you are looking for, but will have long-term consequences from all that added weight stretching and pulling the tissues.  One potential solution is fat grafting.  I can't tell from your picture if you have any fat anywhere that can be harvested and placed on the top and central chest area, but this could potentially help if you do.  Have more discussions with your surgeon, but in the meantime, try to focus on the fact that you have a very aesthetic result!Best of luck!Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Tom J. Pousti, MD · Answer

Thank you for the question. You demonstrate your concerns nicely. I'm not sure that increasing volume of breast implant would be the appropriate solution; adjusting the position of the breast implants and/or utilization of a higher profile breast implant (placed closer to the cleavage line) may be more likely to achieve the outcome you demonstrate. Best wishes.

Francisco Canales, MD · Answer

You have an excellent result. Upper pole fullness like the one photo you have  shown may not be possible on a long-term basis for most patients.  Hollywood "looks" are usually photoshopped or aided by bras.  In your case adding more volume may just make you bigger and with the same shape.  If you were my patient I would not encourage you to add more volume. Best wishes,

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and first of all you have an excellent result.  Next the cleavage you have is the cleavage you have and going larger will only make you a bigger version of what you already have.Dr. Corbin

Arian Mowlavi, MD, FACS (license on probation) · Answer

You are not going to get the upper pole fullness that you desire without repositioning your breast mound position; your breasts are too low when you consider that you have a very long chest; I would highly recommend a breast lift as well as a larger implant. Please see examples below.

No cleavage or upper pole fullness after breast augmentation

Answers (7)

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