Types of cleavage with breast implants

A lot of patients who come in for a breast augmentation 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 prominence 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