Cleavage and closing the gap (Photo)

Dear Eclectic223178,
many women seek improved cleavage. Narrowing the cleavage plane can be done very carefully by a skilled surgeon. Moving the implants too far medially can result in synmastia or unaboob which is very difficult to correct. That being said, the right amount of pocket dissection and implant selection can create excellent cleavage. Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

A vertical mastopexy (lollipop lift) with a modest sized implant will significantly help shape, improve your cleavage and tighten your breasts. See attached reference. Thank you.

Are you getting a breast lift? It may be recommended since your nipples sit lower than your breast fold. The procedure can also bring your breasts closer together to a certain extent. Your surgeon can let you know by how much.

Cleavage lines are very dependent on preoperative anatomy. You have pretty distinct lines and they will likely get fuller. If you're active and looking for a more natural result I would think a moderate or moderate plus implant would be better for your cleavage. Are you planning on getting a lift as well?

If you're not feeling confident with your current plan maybe get a couple additional consultations to make sure all your questions are answered and you're going to get the result you want and/or have reasonable expectations about what you're anatomy can achieve.

Hi Eclectic,
In my opinion, selecting a breast implant size is a very dynamic process between the surgeon and the patient. While breast width can determine the implant width that is appropriate for your body and will not distort your natural anatomy, actual projection (aka profile) and size of the implant is more dependent on a patient's desired aesthetic and lifestyle choices. In my very active patients, it is uncommon that we (patient and I) make a decision to place a very large or high projecting/profile implant, unless requested by my patient. Other measures, such as implant width, selecting a pocket above versus under muscle, or fat grafting to the cleavage are techniques that can be used to create a closer midline cleavage without using an overly large implant.
Best,
Dr. Zamani

The only way you will be able to close the gap is by lifting the breasts using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

The width of the breast is a very important measurement that Plastic Surgeons take during the planning of a breast augmentation. Breast implants need to fit within the footprint of the breast in order to avoid excess “side-boob” and symmastia, also known as “uni-boob.” If a woman has an increased distance between her native breast footprints, I often recommend, in conjunction with breast implants for volume , that we add some fat grafting to the inner portion of the breast, rather than simply adding a wider implant which will not fit properly. This can contribute the problems mentioned above, or can cause a crease to form in the compressed implant which can lead to a rupture due to fold failure.

Thank you for your question and photos. “An examination in person would be required to properly evaluate you and make specific recommendations. That said, “closing the gap” has everything to do with the width of your implant in relation to your breast and chest.

A properly selected implant will make your breasts appear closer in the midline thus closing the gap. The higher the profile and projection for any given specific width, the “bigger” (greater volume) your implant. This means that if you don’t want to be too large and want a “natural” appearance, you will need an intermediate projection such as moderate plus or moderate that still had the proper width.

Please make sure that your plastic surgeon has s good understanding of your wishes and aesthetic goals, and furthermore make sure that his or her aesthetics align with your own.

Based on your photos you can probably have your implant inserted either subfascial or dual plane submuscular. Best of luck to you.

With your anatomy, you will always have a gap. The bases of your breasts cannot be moved. However, bras can push the girls closer together. Please do not chose an implant that is too large and heavy for your tissue and frame. Placing the implant behind the muscle will give nice upper breast fullness and hide the implant edge.