While the placement of implants will always enlarge the breasts, and in most cases very successfully, they may not always create volume on the new breast mound in all of the places where the patient wants it. This is most manifest in the inner side of the breast mound or the so called cleavage area. Many women expect that some amount of cleavage will result from their breast augmentation. While some women do obtain substantially improved inner breast mound fullness, some women do not due to the natural wide spacing of their breasts.
Trying to optimize inner mound fullness requires that the implant be placed as far medially as possible. While there is little limit as to how close to the sternal edge they can be placed in a subglandular (above the muscle) location, submuscular placement is more limiting. The attachments of the pectoralis major muscle to the edge of the sternum provides a physical block as to how far inward the implants will can go. A more aggressive release of the muscle can be done but that increases the risk of ending up too far inward and developing the condition known as symmastia. (implants close to touching or actually touching)
In the April 2014 issue of the journal Plastic and Reconstructive Surgery, an article was published entitled ‘Parasternal Infiltration Composite Breast Augmentation’. In nearly sixty women (59), breast augmentation was done with implants alone (38) or with implants and parasternal fat grafting. (21) The volume of fat injected was 60 to 140cc for both breasts. The parasternal vertical aesthetic line (length of the inner border of the breast against the sternum) was measured before and after the surgery for both groups and compared. The results showed that after surgery the length of the parasternal aesthetic line was much higher in the breast implants alone group than in those implant patients that were fat grafted. No infectious or implant-related problems were seen with fat grafting at the same time as breast implant placement.
Injectable fat grafting to the inner breast mound is another viable option for improving the cleavage area and preventing a widely spaced breast deformity. Parasternal fat grafting performed simultaneously with breast augmentation is proven to be a safe procedure. It, however, has two basic requirements…one must have enough fat to harvest to perform it and it is most safely performed in submuscular implants where the muscle provides a protective barrier.
Dr. Barry Eppley
Indianapolis, Indiana