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Types of cleavage with breast implants
A lot of patients who come in for a breast augmentation or a breast lift with implants consult will usually make a comment about cleavage.
Some patients don’t want “that fake look,” yet others specifically ask for “a lot of cleavage.”
It helps when patients bring in pictures, because cleavage is one of those words that, like “natural look,” can have different meanings to different people. In this post I will talk about cleavage, and how it is related to surgical technique and patient anatomy.
What does Cleavage mean?
The word cleavage is derived from the word cleft. According to the Merriam Webster online dictionary . . .
cleft : usually V-shaped indented formation : a hollow between ridges or protuberances
The misunderstanding between Plastic Surgeon and patient comes from knowing which end of the “V” we are talking about. Does the patient want upper pole fullness, which is prominent at the upper part of the breasts? Does the patient want Medial Cleavage, which is breasts that are close together at the midline? Or is it both Upper Pole Fullness and Medial Cleavage?
The surgeon has two surgical methods to improve cleavage with breast implants.
IMPLANT PLACEMENT
Cleavage can be increased by the placement of the implant. The implant can be placed higher up on the chest wall to get Upper Pole fullness. The implants can also be placed closer to each other on the chest wall to create Medial Cleavage. Naturally large breasts usually have good medial cleavage, but because of their weight they usually descend on the chest wall, so they don’t have Upper Pole fullness.
IMPLANT DIMENSIONS
The second way is by using the implant dimensions. The general rule is, the larger the implant, the better cleavage you will get, both Medial Cleavage and Upper Pole fullness. That is because as implants get larger, their diameter increases, so they occupy more space on your chest wall, both medially on the upper pole of the breast.
CLEAVAGE AND A SMALLER BREAST?
But what if you want Upper Pole fullness or Medial cleavage, but not a huge breast?
Implant manufacturers have responded with a variety of implant dimensions, including 1) implants that have a large diameter and low Profile (moderate profile implants), or 2) High Profile implants that have a small diameter. These new high and low profile implants can really help a surgeon fine tune his choice of implant to get a result as close to the patient’s desire as possible.
A final consideration with regards to cleavage is the patient’s breast anatomy.
The patient’s chest wall and native breast position also have some bearing on final postoperative cleavage, especially medial cleavage. Some patients have an average shaped chest wall, but breasts that are spaced wide apart. It is usually hard to get good Medial Cleavage on these patients. Other patients have a mild or pronounced hollow on the middle of their chest (pectus excavatum), and they usually get a very good medial cleavage. The opposite chest shape where the center of the chest cage is prominent (pectus carinatum). It is hard to get good medial cleavage on these patients. Finally, if your nipple position is low, you may need a breast lift to get the kind of Upper Pole fullness you want.
In summary, when going to see your Plastic Surgeon about a breast augmentation, and you are concerned about cleavage, you would be wise to discuss carefully the final implant choice. If possible, bring pictures of what you have in mind.
It may be impossible to get what you want given your body type, but it helps the surgeon understand your goals and manage your expectations. Secondly, rather than use ambiguous terms like cleavage, use descriptive terms such as Upper Pole fullness and Medial Cleavage that help the surgeon visualize what you want.
Ricardo L Rodriguez, MD
Board-Certified Plastic Surgeon
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12 Comments
January 15, 2012 at 5:37 pm
Odalys:
After seeing your pictures there are a few things that come into play.
There is fat redistribution. When you get a Tummy Tuck with a breast reduction and lipo, it’s not like the fat will disappear. As long as your calorie intake is the same and your exercise calorie expenditure is the same, you will slowly build up your weight to what you weighed before. Sometimes you pick up fat in the lateral aspect of the breast, so even if the breast is smaller, the extra fat buildup in the lateral chest fills up the bra.
I don’t use that pattern for breast reduction, I use a vertical scar. It gives you more lift and projection.
We’d love to help you, call Kelly@kelly@cosmeticsurg.net, she’d love to help you out.
January 8, 2012 at 9:21 pm
Thank you so much Dr. Rodriguez, you were honest and straight to the point. Happyt New Year by the way! I attached a link of my post to give you a better idea of what I’m talking about. It’s before surgery, right after, and basically today i still look like the last picture which is smaller, but still saggy and basically the same. I hope implants will help correct the problem and your left corner patient would be a great result for myself.
Thanks again!
http://www.realself.com/question/lift-4-months-unhappy
January 8, 2012 at 3:30 pm
Odalys:
I hate to give you advise on this because it will put your surgeon on the spot and he has his own way of doing things.
You are better off printing my picture and showing it to him and asking him what the best way is to get something like in the picture. Remember: “LIKE”, you are not going to get a result exactly like in the picture because you are starting from a different point.
BTW, the patient has the implants behind the muscle.
January 8, 2012 at 3:25 pm
“Narrow Pelvis”
You are right that if you have a narrow pelvis, when viewed from the front you may still lack width. This implies that you will have good projection
In this case, I would just inject fat into the area of the greater trochanter (“saddle bags”). I have done this in the past and it works great.
December 25, 2011 at 5:12 pm
Hello! First and foremost, Happy Holidays! Dr. Rodriguez, I came across your article through real self and I have a few question. I was a 36DD preop extremely saggy super full of stretchmarks (I’m 24). I had a BL/BR with no implants and of course, the day of surgery, it looked awesome but it only took a few weeks to look the exact same as before surgery only smaller. My surgeon and I agree I have poor skin laxity and the skin is generally thin. I love the picture of the breasts on the upper left corner as I would hate for my implants to look anyother way. Exactly where are the implants placed for this specific patient. I have discussed with my doctor getting 350cc behind the muscle and hope to achieve these results which I hope will last more than a few weeks. I’m 7 months post op. Any advice? Thanks!
June 26, 2011 at 9:28 pm
Lucia:
Glad it helped you!
June 23, 2011 at 3:55 pm
I had a breast augmentation two months ago, and my breasts were too close together. I do have wrinkles between my breasts from sleeping on my side, too. The Intimia pillow actually helped me, they don’t look like a uni-boob anymore, and my wrinkles are much smoother after every night I wear it. I would never go to bed without Intimia, I love it! It’s so comfortable, too. I could not wear a bra to bed, it’s too uncomfortable. No doctor can tell me otherwise, I’ve tried it for myself.
May 14, 2011 at 4:37 pm
Cindy:
I usually don’t respond to spam, but this time I took the time because I thought it would help patients.
This product is THE WORST THING YOU CAN DO if you want to improve your cleavage after a breast augmentation. As a matter of fact, it is designed to keep the breasts APART after surgery, which will give the breasts an appearance of being far apart with a huge gap in the middle.
This product claims to decrease the wrinkles between the breasts by SEPARATING the breasts. Whether that works or not is to be debated, and there is ABSOLUTELY no studies proving that it does.
May 13, 2011 at 1:02 pm
I would also recommend that you try using the INTIMIA breast pillow ( better than sleeping with a bra/pad etc). It is amazingly comfortable, soft and light weight. It will keep your breasts in the perfect position during sleeping, avoiding the formation of cleavage wrinkles and pressure while asleep. It is AMAZING. check it out at http://www.initimia.com
January 2, 2011 at 5:42 pm
Louise:
It all depends on how the surgery was done, how long ago it was done, and your body type.
After 2 weeks or so it will be very hard to change the position of your implants.
Some women have chests that are more prominent at the breast bone, and it is very hard to get cleavage in these cases.
If anything, I would place pads on the side of your breasts inside the bra, to push your breasts medially.
In your particular case I would need more information before making a definitive recommendation.
December 29, 2010 at 5:19 pm
can i tape my boobs to make them closer .Had surgery and they are separated. Can you recommend a tape?
March 28, 2009 at 6:47 pm
Hello!
Very Interesting post! Thank you for such interesting resource!
PS: Sorry for my bad english, I’v just started to learn this language
See you!
Your, Raiul Baztepo
2 Trackbacks
[...] From what I’ve read (correct me if i’m wrong ladies)… Upper pole fullness is when there is a lot of upper cleavage like up top like down from ur collar bone… kinda like what a push up bra does. While medial fullness is cleavage like right in the middle of your boobs. Its a good term to know.. that way when you walk in for a consult you can better describe exactly what you want. That way instead of just saying "I want great cleavage" which can mean a thousand things you can kinda pinpoint what kind of cleavage ya want. Here is a link to a pic of a couple of kinds of cleavage not really as clear of a pic as what I’d like to show u but the site has some pretty clear info where he explains it a lot better than I can http://www.cosmeticsurg.net/blog/200…east-implants/ [...]
[...] your stomach area? Do you want tighter skin or more interested in a leaner profile? With breasts, do you want more cleavage or upper pole fullness? Different cultures and ethnicities view beauty with different eyes. Do not assume your doctor [...]