Should I Have Went Under the Muscle? How Do I Get Better Cleavage?

I would recommend new lower profile implants silicone placed under the muscle. This should get you more cleavage. Your breast cleavage pre op appears to be 2-3 cm which is not bad.  

Based on your pre-op picture, I would have certainly recommended placing your implants under your chest muscle in order to give you better coverage over your implants.  This would have minimized the potential for ripples/wrinkles which could be seen or felt but also minimized the risk for developing capsular contractures, the constriction and distortion of the breasts which you seem to have developed.  You had a wide chest bone before surgery and this is what determines your cleavage.  Implants will give you volume but push-up/push-in type bras will give you cleavage.  Surgical attempts to give you cleavage may end with a bad result.  My suggestion for you would be to remove the capsules that have formed around your implants and re-position your implants into the submuscular (under the chest muscle) position.

but if you are developing a contracture, you should see your doctor about what options you have.  Cleavage in and of itself is not determined by whether your implant is above or below the muscle but more on how your pocket is created.  Your inferior medial pockets seem a little flattened and its speculation as to whether that is from capsular contracture or your pocket dissection.  Regardless, if you wish to fight the contractures, you will have to consider more surgery and you should know all of your options, including new implants, textured anatomic implants, and new pocket dissection.  Your nipples are always going to be pointing outwards as that is what you started with and your implants are only aggravating that.

When the implants are placed under the muscle the closest you can get the implant to the midline is the edge of your breast bone.  If you have a wide breast bone or sternum or breast bone it will not be possible to achieve as much cleavage as an individual with a narrower breast bone.  You may actually have a mild to moderate capsular contracture and this is preventing you from being able to push the implants toward the middle.  You may be a candidate for a revision and submuscular placement of the implant.  

It sounds like you have answered your own question about whether you should have gone under the muscle.

But don't despair, have a chat with your plastic surgeon and see what he/she recommends to do now.

Going bigger would have made the rippling worse over time as it would only thin out the upper pole breast tissue.

We take our patients as we find them.  If you have a larger space between the breasts, an augment will accentuate this.  I would have recommended going under the muscle, particularly if you have very little breast tissue.  You could consider revision and placement under the muscle.  I don't think that going larger would be beneficial.

There are a number of reasons that some surgeons would have recommended under the muscle placement, though better cleavage is not one of them. Capsular contracture is less common, and often the appearance at rest is more natural. 

When a patient's natural breasts are widely separated, cleavage is not going to be accomplished. If the breasts are wide, so is usually the insertion of the pectoral muscles into the breast bone, and this may result in still further separation of the implants. 

Other than for the capsular contracture which is distorting the right side, I think your outcome is otherwise quite good. I would suggest discussing with your surgeon the non-operative approached to capsular contracture. If those fail, an operative approach should include consideration of moving the implants behind the muscle.  Best wishes.

A good portion of your result from breast augmentation surgery begins with your own anatomy. You do have very thin tissue coverage, and a wide lower sweep to your cleavage that appears to be slightly ineven on the left and right. Your right breast appears a bit wider than the left.

My impression is that your surgeon attempted to correct your cleavage by raising the skin, but may not have taken it all the way to the bottom of the breast. The risk of doing this is connecting the two breast (symmastia) by disrupting the tissue between.

Looking at your photo, it seems to me that your implants may actually be too wide for your breast footprint. It may be to your benefit for them to be placed under the muscle and moved closer together. Of course, an examination would be required to be sure of this. The trade-off of putting the implants under the muscle is an animation deformity, where the muscles are visible when you flex. However, the improved coverage may well be worth it.