Unable to Obtain Cleavage After Breast Augmentation

I had a breast aug on 23rd September 2010. I went from an empty 32AA to a 32D with 230cc unders.I have had concerns following surgery. Firstly my breast are still firm and quite painful and secondly they are very far apart and I am unable to obtain a cleavage. I have read that lack of cleavage may be due to anatomy before surgery and if this is the case then I will have to accept that the surgeon did his best yet I do suspect CC. I hope you can help as I am having trouble getting to see my PS.

Doctor Answers 9

Dangers of creating cleavage in thin patients: visible implant ripples and webbing or synmastia ((uniboob)

The dangers of creating cleavage in thin patients: visible implant ripples and webbing or synmastia ((uniboob)

Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

See your surgeon about possible capsular contracture

Post-operative cleavage will always be determined by the natural distance that exists between the inner edges of a woman's breasts and the distance between her nipples. When performing breast augmentation, although the implants can be cheated closer together a small amount, they still must be centered more or less beneath the nipples. Placing them elsewhere will lead to an unnatural appearance. This means that patients will have cleavage similar to their natural state even after their augmentation results become visible. This may be what happened to you.

Please see your surgeon as soon as you can regarding the firmness and pain you're experiencing. You may be right, you may have capsular contracture.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Lack of cleavage

The amount of cleavage after surgery is relative to the amount you had before surgery. In  many ways your cleavage is determined by your underlying anatomy.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Lack of cleavage after breast augmentation

The lack of cleavage that you demonstrate is an anatomic issue- more than likely, you have sub-pectoral implants, and started with fairly widely spaced breasts. This combination results in widely spaced implants. Discuss your concerned with your plastic surgeon. Its unlikely that capsular contracture at this early stage ahas anything to do with your post op appearance.

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 65 reviews

Capsular contractures

Your description  of firm, immobile and painful breasts four months after surgery fits the description of capsular contractures.  Often the implant moves upward and the nipples are tipped downward ( your photos are not the best, but do look like this may be the case).  This is a problem that needs to be corrected.  I would call your surgeon's office and let them know that you are in pain and need to be seen sooner rather than later.  If this request cannot be honored I would recommend you call another board certified plastic surgeon who will.

The matter of cleavage is a separate concern.  Your breasts are widely spaced and your natural breast tissue does not extend even to the edge of your breast bone (judging by the photos).  The implants need to be centered behind the nipple.  If they are positioned closer to the midline your nipples will shift toward the outsides of  your breasts.  In my opinion cleavage is not a realistic expectation for you. It may be possible to approach that goal with a push-up bra, but not  in the presence of capsular contractures.

Lori H. Saltz, MD
San Diego Plastic Surgeon
4.3 out of 5 stars 28 reviews

Cleavage after Breast Augmentation

I cant give a detailed opinion based on your photo, but I can suggest a few points

  • Most of you pain should be resolved by six weeks post operative
  • Your breasts should be softening by six weeks, not getting firmer
  • Not all patients can get cleavage after breast augment, it depends on their specific anatomy, not on the size of the implant

If you have concerns following your procedure, you should return to your surgeon who will be able to give you some more specific information.

Mark Preston, MD
Columbus Plastic Surgeon
4.4 out of 5 stars 21 reviews

Pain after breast implant surgery

It is hard to say with the type of photo you posted but the implants do not look centered under the nipples. This may be because before surgery the nipples were not in the optimal position. It also may be that raising your arms for the photos has created a distortion. If the nipples were out of position before surgery and you did not want them shifted into position because of the additional skin scars that would necessitate that is one thing. If they were out of position and you were not notified of this, surgery was not planned around that and you were not given the option of the additional surgery that is something else.

With respect to cleavage -it cannot be created by breast implants if it did not exist before surgery.

The issue of pain is a potential problem especially 4 months out from surgery. There is nothing I can see from the photo that would explain that. You really need to be seen by the surgeon who did your surgery. It is not clear why you are having trouble getting to see your surgeon. If you are busy and just cannot find the time then the pain cannot be that bad. If it is because geographically you are far apart that is something you will have to resolve and is a problem if you travel long distances for cheaper surgery. If it is because the surgeon is making him/her self scarce that is a bigger problem and a factor that should have been taken into account when choosing your surgeon.

From a visual standpoint excluding pain I am not sure revision surgery is worh it as the results are not that bad and more can be the enemy of better.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Obtaining Cleavage After Breast Augmentation

Four months after your surgery, you should have recovered from all the pain and discomfort associated with your breast augmentation. The implants should be soft and freely mobile.  The lack of cleavage is frequently associated with your anatomy before your surgery.  The implant should be situated centrally behind the nipple for the most attractive result.  If your nipples are naturally located more to the outside of your breasts, then it is difficult to achieve both cleavage and appropriate placement of the implant as they are somewhat exclusive. 

From your photographs, your right implant appears to be high with the nipple on the lower aspect of the breast - this looks like it could be capsular contracture.  Also, it does appear that your nipples are more laterally placed and thus, you will have difficulty achieving optimal cleavage outside of a bra.  A wider based implant can help if you look to a revision procedure.

Best of luck

Vincent Marin, MD

San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews

Capsular Contracture After Breast Augmentation

Four months after surgery your breasts should not be painful. Based on the photograph you provided and your description, you likely have a capsular contracture. Capsular contractures have the following signs and symptoms:

1. Firmness in the breast  with limited movement of the implant with breast massage

2. Distortion of the breast shape, especially becoming fuller in the upper portion and narrower as the capsule becomes more firm.

3. Pain is associated with more severe capsules.

With capsular contracture, the breasts can look farther apart and so your lack of cleavage can be a combination of preoperative anatomy and capsular contracture. You really need to be seen by a plastic surgeon.

Hope that helps and good luck!

Dr. Babak Dadvand

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 44 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.