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Roy Kim, MD

Plastic Surgeon in San Francisco and Beverly Hills
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Roy Kim, MD

Plastic Surgeon in San Francisco and Beverly Hills

Cleavage is one of the most discussed topics among women considering breast augmentation. Yet, there’s often a disconnect between what patients envision and what plastic surgeons aim to deliver. Understanding how cleavage is created-and the factors that influence it-will help you communicate your goals clearly and achieve a beautiful, natural result.

What Is Cleavage? Patient vs. Surgeon Perspective

Patients usually define cleavage as:

  • The distance between the breasts

     

  • The fullness of the upper (superior) portion of the breasts

 

Plastic surgeons use the term

  • Call it  intermammary distance to describe the space between the breasts. 

 

  • Ideally, breasts should be close-but not touching-without support. 

 

  • If implants are so close that the breasts touch in the center, it can lead to symmastia (“uniboob”), an unnatural and undesirable outcome

Key Factors for Ideal Cleavage

1. Implant Size, Shape, and Profile

  •  Width of Implant or Diameter of Implant: Implants that are too large or too wide for your chest can push the breasts too close together, increasing the risk of symmastia.

 

  • Volume: the more volume, the larger the implant will be.

 

  • Profile: “Profile” refers to the thcikness of the implant, or how much the implant projects forward. Higher-profile implants can provide more upper pole fullness, enhancing cleavage, but must be chosen carefully to avoid an unnatural look.

 

  • Shape: Round implants typically create more cleavage than teardrop-shaped ones because of their wider base and more volume at the top/ superior portion of the breast.

2. Implant Placement

  • Submuscular (under the muscle): Offers more natural support and reduces the risk of symmastia. The pectoralis muscle acts as a buffer, keeping implants from migrating toward the midline. However, it is less controllable in terms of how close the implants can be, since the pectoralis muscle actively pushes the implants laterally, towards the underarm or side of your body.

 

  • Subglandular (above the muscle): May create more cleavage initially, but increases the risk of implants if not done properly, since the implants can move too close together, especially if large implants are chosen

3. Pocket Creation and Surgical Technique

  •  The implant pocket must be sized and positioned precisely-not too close to the midline, not too far apart. The surgeon’s experience is crucial here, as improper pocket creation is a leading cause of cleavage issues and symmastia

 

  • The implant should be centered under the nipple for symmetry and natural appearance.

4. Your Anatomy

  • The width of your chest, the distance between your breasts, and the amount of natural breast tissue all influence how much cleavage is achievable. 

 

  • Some women naturally have wider-set breasts, which can limit how close implants can be placed without risking complications

5. Fat Grafting

In select cases, fat grafting can be used to enhance cleavage by adding volume to the inner breast area, especially if implants alone can’t achieve the desired look.

Cleavage Expectations: Natural vs. Supported

  •  Without Support: Plastic Surgeons evaluate cleavage with the patient standing, arms at the sides, and no bra or support. This “clinical” view is the baseline for surgical planning.

 

  • With Support: Most patients think of cleavage as it appears in an underwire bra or push-up dress. Supportive garments can push the breasts together and upward, creating more dramatic cleavage than what’s naturally possible post-surgery.

 

So, there is a difference between cleavage with no support (no underwire, no bra) versus cleavage WITH support (underwire bra or equivalent).

Tip: Bring “inspiration photos” to your consultation and specify whether you want your cleavage to look a certain way with or without support.

Avoiding Symmastia (“Uniboob”)

 Symmastia is when the breasts merge at the center, losing the natural valley between them. It is rare but can occur if:

  • Implants are too large or too close to the midline

     

  • The implant pocket is over-dissected

     

  • Subglandular placement is used in petite patients with large implants

     

Prevention:

  • Choose implants sized appropriately for your chest, and are not too wide for your chest measurements.

 

  • Trust an experienced, board-certified plastic surgeon who understands proper pocket creation and implant selection

 

Correcting Cleavage Issues After Surgery

  •  Implants Too Close (Symmastia): Revision surgery can reposition the implant pocket, sometimes using internal sutures or adding a tissue matrix to keep implants separated

 

  • Implants Too Far Apart: Surgeons may use a procedure called capsulorrhaphy to bring the pockets closer together, or select wider implants if appropriate

Practical Steps to Achieve Your Ideal Cleavage

  1. Consult with a Board-Certified Plastic Surgeon:
     Discuss your goals, anatomy, and review before-and-after photos to set realistic expectations
  2. Choose the Right Implant:
     Consider size, shape, and profile that fit your anatomy and desired look
  3. Discuss Placement and Technique:
     Ask your surgeon about the benefits and risks of submuscular vs. subglandular placement.
  4. Understand Limitations:
     Your natural anatomy may limit how close your breasts can be placed safely.
  5. Follow Post-Op Instructions:
     Wear recommended support bras, attend follow-ups, and allow time for implants to settle.
  6.  

FAQs: Cleavage After Breast Augmentation

1. Can I choose how close my breasts are after augmentation?

To some extent, yes-but your natural anatomy and chest width set the baseline. Your surgeon will work to achieve your goals within safe limits

2. Will my cleavage look the same with and without a bra?

No. Supportive bras or outfits can create more dramatic cleavage than what’s naturally possible without support

3. What if my implants are too close or too far apart after surgery?

Revision surgery can often correct these issues, but it’s best to prevent them with careful planning and an experienced surgeon

4. Which implant placement is best for cleavage?

Subfascial is a great approach, due to the ability to create a pocket for your implants with some support holding your implants in place by placing them above the muscle, but under the fascia.

5. Can fat grafting help with cleavage?

Yes, fat grafting can enhance inner breast fullness and cleavage in select cases.

6. How do I communicate my cleavage goals to my surgeon?

Bring inspiration photos and specify whether you’re referring to cleavage with or without support.

Conclusion

Achieving ideal cleavage after breast augmentation is a blend of art, science, and communication. By understanding the factors involved and working closely with your plastic surgeon, you can set realistic expectations and enjoy beautiful, natural-looking results. Always prioritize safety and anatomy over trends, and remember: the best cleavage is one that complements your body and makes you feel confident.

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