What direction will implants point?

Let's think about the anatomy of this area in general , and then specifically in your case.

First of all, if you take the upper chest (at breast level) and do a CT or MRI scan you will see a "slice" of the chest that shows an normal oval shape. The center of the sternum (breast bone) faces forward, and the ribs start curving towards the sides of your chest, and then around to your spine. Your breasts are on the sides of this oval, and therefore point somewhat to the sides--normal breasts DO NOT point forwards!

Actually, there are rare cases of chest wall deformity such as pectus excavatum where the breastbone is "caved in" to a varying degree in different patients, and the ribs on either side curve inward at the center and are facing forward at the breast level. This leaves the breasts pointing straight forward with an unnaturally-deep cleavage. However, as discussed above, the normal nipple areola direction of pointing is somewhat towards the side.

Cleavage is achieved by increasing breast volume (size) so that there is more tissue to push towards the center (in a bra or otherwise) in women with normal ribcage anatomy, and is more easily achieved in women who have a pectus excavatum deformity of the chest wall.

Looking at things another way, your nipples are NOT 1 inch from the side--they are centered directly atop your breast mounds, which point towards the sides when someone looks at you directly from the front (as you see yourself when you stand directly in front of a mirror). If you rotate towards the sides so you face one of your breasts (but not you) "head on," you will have equal amounts of breast tissue on each side of the nipple. Thus, from the front, you will have "side boob," in an amount equal to the volume of tissue (or implant) towards the center or cleavage area.

I have always told my patients that deep cleavage is usually the province of a good push-up bra--but you have to have something to push up or towards the center! Big(ger) implants help, but do not guarantee a deep cleavage. And the implants chosen must have the proper width to height ratio (profile) so that there is not too wide a gap between implant edges in the center. High profile implants tend to give more "forward" projection, but a the cost of being narrower for a given implant size, leading to too-wide cleavage in some cases. This is why lower profile implants (up to the proper dimensions of the chest/breast bases) will yield the most pleasing cleavage.

Implants that are too wide (too large) for the dimensions of the recipient area (either because of patient or surgeon poor choice) can increase the risk of symmastia (uniboob).

Your anatomy is normal, albeit with a more curving chest wall that emphasizes your natural "point towards the side" breast orientation. Choosing large(r) implants with the proper base diameter (probably moderate profile, NOT high profile) will help you and a pretty bra achieve you goals! Best wishes! Dr. Tholen

In your photograph, your breasts are asymmetrial, have minimal cleavage and are pointing laterally.  I would recommend a new procedure called Breast Augmentation with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall, more medial to increase cleavage and place silicone gel implants.  Retro-pectoral implants look and feel more natural and are less likely to ripple.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall gives maximum anterior projection with a minimal size implant, which is more stable long term.  Using this technique, you can control the direction that the implants point.

Best Wishes,

Gary Horndeski, M.D.

 

Without ancillary operative procedures a breast augmentation will simply make the breasts larger without significant change in shape. Nipples the point down a preop point down out postop and so