Without pictures, it is impossible to say what may or may not be possible. Often, your own anatomy dictates how and in what position the implants need to sit. If you naturally have a wider sternum, there really may not be much you could do to improve this. The best thing to do is to consult with your board-certified plastic surgeon and see what they recommend.

Published on Jul 11, 2012

The problem may be that you have a wide breastbone (sternum). Ordinarily, it's about 4-5 cm wide, which is about 2 inches. I have had some patients whose breastbone is 4 inches wide. When breast implants are placed under the muscle, they can't give much cleavage with a wide breastbone because the muscle attaches to the edges of the breastbone. In that situation, it's better to go on top of the muscle with a gel implant and close down the lateral edge of the breast pocket to push the implants more towards the middle.

Published on Jul 11, 2012

Usually, the larger the size the greater the cleavage. If you were totally without breast tissue, maybe the breast pocket into which the implant was place was opened too far laterally. This could be done with the same implant but I would make a "neo" pocket.

Published on Jul 11, 2012

Improved cleavage may be able to be corrected with a secondary procedure and same implants. It will depend on a few factors, but most importantly the skill and technique used by the surgeon. I use a technique called "complete muscle coverage," which allows me to place the implants in a way that yields attractive cleavage.

The most commonly used "standard under the muscle" makes it very difficult to achieve nice cleavage without having to compromise the size of the implant. Your current surgeon would have to know how to perform complete muscle coverage breast augmentation.

Published on Jul 11, 2012

Thanks for your question. There are several reasons that your breasts may appear too far apart. Much of those reasons are dependent on where your breast tissue base and your nipple-areola position were prior to surgery. There are certain circumstances in which it's really not possible to position the implants closer together due to your anatomy and/or whether it would cause your nipples to be positioned too far to the side and/or pointing outward.

If that's not the case, and the implants could be moved closer to the middle of your chest, there is a procedure that can be performed in which I would place dissolving mesh to provide support (kind of like an internal bra), and that could be done without changing the size of your implants.

I hope that's helpful, and please reach out with any additional questions. Thanks again!

Published on Jul 11, 2012

Patients must understand the limits of the surgery. Implants will not create cleavage in the sense that they cannot medialize wide or lateral set breasts. The implants will be centered on your native breast mound, which may seemingly worsen the wide set nature of the breasts without actually changing the measurements.

It is often helpful to think of breast augmentation as a magnifying glass or IMAX screen where all aspects of the breast are enlarged (+) and (-).

One option for creating a more central or medial mound is subglandular augmentation. In this scenario, the medial boundary as defined by the pectoralis muscle attachments to the sternum is not present. This can allow for greater medial dissection and, by association, greater cleavage.

However, this is not recommended. Over-dissection increases the risk of symmastia. There is also the risk of deformity, which stems from a failure to center the implant on the native breast mound.

Ultimately, cleavage is essentially a function of the anatomic starting point. If you have wide set breasts, implants are only likely to accentuate this deficit. However, patients with closely spaced breasts will accentuate their cleavage via augmentation.

In my practice, most patients do well with a mod (+) profile device. Those with a narrower frame may choose a higher profile device for greater projection and volume at a given width. An ultra high profile would be further along on this same continuum. Fullness will change with greater volume, cleavage will be unaffected (outside of a support garment).

With regards to your particular question, subglandular placement can be used to address wide set breasts, however, this is not without risks. When placed under the muscle, the muscle acts as a barrier to migration of the implant across the midline. They cannot be forced anymore to the middle than the muscle will allow. There is no such barrier for subglandular ("overs"). However, while this does allow for the creation of cleavage, there is a risk of over-migration and symmastia.

As always, discuss your concerns with a board-certified plastic surgeon (ABPS).

Published on Jul 11, 2012