‘My breasts are sagging and I am a 36 B. I want to have breast augmentation to make them bigger. What worries is that my breasts are too spaced pretty far apart and I would like nice cleavage. How can I be sure that I will have good cleavage after my breast implant surgery?’
This is an incredibly common question and objective for many females considering breast enhancement. This patient has astutely observed her widely spaced breast ‘problem’ and is asking about it before surgery. Many patients, however, are unaware of their breast spacing but are equally expectant of good postoperative cleavage.
The amount of cleavage that can be present after breast augmentation will vary greatly depending upon the unique characteristics of each patient’s chest wall anatomy. Important variables include the width of the chest wall and rib cage, the prominence or lack thereof of one’s sternum, the natural separation of your breast mounds and nipples, the location of the nipples on the breast mounds and the amount of angulation or divergence of the breast mounds from the sternum. (sternal-rib angle)
To achieve the best and most natural look, breast implants need to be placed so that they are centered behind the nipple-areola complexes. The implants need to extend as much to the side of the chest wall as they do towards the sternum underneath the nipple. This implant location is more important than getting the implants close to the sternum for cleavage purposes. If the implants were to lie closer together than the nipple position would allow, the nipples will end up pointing outward creating a ‘wall-eyed’ effect or look.
In widely spaced breasts, therefore, natural cleavage may be impossible. Cleavage may only be obtainable in significant breast separation with the use of very large implants, which may be disproportionate for one’s body frame. It is important for such patients to realize that few women have breasts that will have cleavage, without a bra, after augmentation. ‘Synthetic’ cleavage (i.e., a bra) is needed by most women whether they have breast implants or not.
The spacing between your implants depends on the spacing you have naturally between your breasts before surgery. Some women have wide sternums or breast bones and some have narrow sternums. If the implants are placed too close together, an artificially-created cleavage will result. The skin over your sternum or breast bone is very thin and if the implants are placed too close, you will likely seem the edge of the implants.
Discuss your cleavage concerns with your plastic surgeon BEFORE your breast augmentation surgery. Find out what is realistic and what can be done given your anatomy and the location of your breast mounds. Good cleavage after breast augmentation, without a bra, is actually very uncommon.
Dr. Barry Eppley
Indianapolis, Indiana