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Background: Size dominates much of the preoperative discussion in breast implant surgery and what volume of implant may achieve it. But right behind size are concerns and desires for postoperative breast shape. The shape of the breast is defined by fullness of the upper and lower poles and the position of the nipple-areolar complex on the reshaped mound.

One other shape consideration is the spacing between the two breast mounds or cleavage. Many patients erroneously assume that breast implants will automatically create good cleavage as the breasts become larger….but this is actually not common. In most patients the augmentation effect occurs more in the lateral two-thirds thirds of the breasts than it does in the inner third near the sternum. This is particularly relevant in the submuscular pocket location where the pectoralis major muscle limits medial enlargement of the breast mound as much as it does in lateral enlargement. Placing the implant in the subglandular pocket gets around the limitations of the muscle and is more prone to create increased cleavage.

Having naturally closer breast mounds, even if they are small in size, is the best predictor of improved postoperative cleavage after implant augmentation. This is particularly relevant if the implants are being placed in the submuscular pocket.  The more implant volume that is placed with this anatomy the more significant the cleavage will be.

Case Study:  This 35 year-old Hispanic female desired breast augmentation to increase her cup size to a ‘small D’ cup. She opted for silicone implants and wanted a transaxillary insertion approach.

Under general anesthesia and through high axillary fold skin incisions, 550cc smooth round moderate plus profile implants were placed in the submuscular pocket using a funnel insertion device in a no touch technique.

Her postoperative results show that with the right preoperative breast shape and position cleavage without a bra is possible.

Case Highlights:

1) The placement of breast implants merely magnifies what the natural shape of the breasts are. If breasts are widely spaced they will stay that way even with implants in place.

2) Close breast spacing is the single most important predictor of achieving postoperative cleavage in beast augmentation surgery.

3) The second most important contributors to creating cleavage is the size of the breast implants and what pocket location they are placed.

Dr. Barry Eppley

Indianapolis, Indiana

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