I am worried about a wide cleavage.
Probably the second biggest fear that patients having breast enlargement have is that they will be left with a wide cleavage (the first biggest fear is that they will look like Dolly Parton or Jordan).
This is not something that I see very much in my practice, but when patients search on the internet they find photographs of women with abnormally wide cleavages and they are worried that they might end up looking like this.
This sort of result is an unnatural look and is usually caused by having implants placed in a submuscular plane without releasing the muscle sufficiently in the cleavage area.
Don’t worry so much about the size of the implant
I always make a point to my patients that choosing the size of the implant is an important part of the process to get the desired result. However, it is only one small part and I find that patients worry an awful lot about this and put a lot of importance on it. I see patients who have a lot of angst and sleepless nights trying to decide between two implants which may have 30cc or 50cc difference between them and so would not give dramatically different results. What is more important than the size of the implant is the shape of the implant, both in terms of its width and its projection and whether it is round or teardrop shape.
The position of the implant is crucial
The other thing that is crucially important is positioning of the implant as it does not matter what implant you choose, if it is not positioned correctly, then you will not have a good result. However, positioning the implant is entirely in the hands of your surgeon and is not something that patients tend to worry about but it is a reason to make sure that you choose you surgeon well and have confidence in his or her abilities. A widely spaced cleavage is an example of an implant that has not been positioned well.
What causes a widely spaced cleavage?
When making a space underneath the muscle there are quite large blood vessels supplying the muscle in the cleavage area. Surgeons like myself, who have experience of microsurgical breast reconstruction are very familiar with these blood vessels as we actually dissect them out and connect them to blood vessels from pieces of tissues transferred from the tummy in order to reconstruct the breast after mastectomy. It is very important to be aware of the presence of these blood vessels because this area needs to be adequately released in order to place the implant in the right position to enhance the cleavage. If the muscle is not adequately released, it can pull the implant sideways creating this very wide appearance which looks unsightly and unnatural.
Having said this, I always stress to my patients that the appearance of the cleavage area does differ between individuals. Some individuals have breasts that sit quite close together whilst others are slightly more widely spaced. The aim of breast augmentation surgery is to enhance the natural breast that you have. The examples below show good results with a pleasing enhancement of the cleavage area but you will note that the patient on the top has a slightly wider cleavage naturally than the patient on the bottom.
Push up bras
The other important thing to note is that these photographs are taken with no clothes on and it is possible to manipulate the position of the breasts with clothing. There are bras which can push the breasts together to enhance the cleavage or push the breasts up to make the upper part of the breast look fuller.
Surgery is all about enhancing the natural breast. There are some circumstances where the position of the breast may need to be manipulated or changed such as in cases of breast asymmetry or differences in the inframammary fold height or in tuberous breast deformity and so different skills may need to be utilised here. However, for many patients the breasts are in a natural position and breast implants can achieve an enhancement of this and an improvement in the size and shape of the breasts.
Choice of surgeon is more important than choice of implant
I hope this blog post has been useful. At the Staiano Clinic we try and empower patients and give the information that you need to make an informed decision. We do not wish to over complicate things or for you to get bogged down with small details, but it is important for you to know that the training and experience of your surgeon is critical because there is a lot more to getting a good result with breast implants than simply choosing the right size of implant.