Mind the gap: The Cleavage Conundrum


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With so many options available for breast implants, and so much information available, patients are becoming increasingly particular about their desired results. This is especially true for the cleavage area. It may be that because this is more likely to be exposed, and too wide a gap can be a tipoff to breast implants. On the other hand, too narrow and you risk a condition called symmastia, where the skin between the breasts actually pulls up. So how do we get it just right?

Implant placement and diameter are equally important in creating a natural cleavage. When implants are placed under the muscle, as most are, the anatomy of the muscle limits how close the implants can be. Since the pectoral muscle attaches along the sides of the sternum, or breast bone, it actually tends to push the implants to the side. In some cases, this contributes to the implants falling to the side. (This can be fixed with an internal bra; see before & after here.) But routinely placing the implants in front of the muscle can lead to unnatural visibility of the implants, particularly in thin patients. Finding the right balance requires experience, and sometimes the cleavage just cannot be as close as the patient might want without risking other problems.

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Implant diameter is almost equally important. The existing width of the breast determines the maximum diameter, but the implant should not be too narrow either. Too wide and there will be excess “side boob,” too narrow and the cleavage gap is too wide. The shape of the chest and rib cage influences cleavage too. Often the rib cage slopes to the side, which encourages the implants to slide apart over time. The opposite can occur as well, a condition called a pectus excavatum. This is an indentation of the breast bone between the breasts, where they may fall toward the middle. If the chest wall is flat across the front, the surgeon has more control over placement.

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So as the London subway system famously advises, “mind the gap.” Just don’t obsess if it is bit too wide or narrow, as long as the implants are the right size and dimensions for your body.