Breast implants and cleavage appearance have become synonymous issues in breast augmentation. However, it is important to note that the “starting” anatomy of the patient—the natural distance between the breasts and the nipple position—will have a large impact on the final result.
In general, after surgery patients will have a cleavage quite similar to its natural or pre-operative state. Nonetheless, there are certain steps that can improve the distance between the breasts without causing unnatural appearance and other complications.
Leading Los Angeles plastic surgery expert Dr. Tarick Smiley says good results starts with correct implant size and meticulous pocket dissection.
Excessive lateral dissection of the implant pocket can lead to malposition, resulting in the appearance of breasts that are abnormally far apart. To prevent this from happening, Dr. Smiley emphasizes the importance of surgical precision to prevent implant displacement.
Despite meticulous pocket dissection, some patients remain susceptible to implant malposition due to their loose skin or weak fascia and ligaments. This might be true for some women aged 55 years and above who may benefit from the use of biological mesh called acellular dermal matrix.
ADM works as a “sling” that will support the implant’s weight, thus preventing the prosthesis from migrating too low (sagging) or too laterally (excessive lateral bulge). And because this is derived from cadaveric skin whose cellular components are removed, except the basement membrane or “foundation,” the risk of rejection and viral contamination is nearly absent.
To further promote better cleavage, meticulous implant selection will also play a critical role. In general, the implant’s horizontal width and projection must reflect the patient’s natural breast and chest measurement.
However, patients with adequate breast tissue could tolerate an implant whose width slightly goes beyond the chest/breast horizontal dimension in an attempt to narrow the gap between the breasts. It is important to note that this will not work on women with little soft tissue coverage because of the increased risk of wrinkling (along the implant’s edges) and palpability.
Despite the use of correct implant dimension and meticulous pocket dissection, some patients may still opt for fat injection to further improve their cleavage appearance.
Fat injection is basically a reversed liposuction in which the “unwanted” fats are collected from two or more areas, purified usually with the use of centrifuge, and then re-injected into the area that needs additional soft tissue coverage or augmentation.