Why Don't I Have Cleavage After Breast Implants?

In general, no — but it certainly can happen. The first thing to consider if you're having a breast augmentation is: what does your natural anatomy look like? What does your chest wall look like, and what do your breasts look like?

When it comes to chest wall anatomy, it's important to look at the center of your chest and also how your chest wall is tilted.

Sternum shape:

• Pectus excavatum (sunken sternum) — These patients get more cleavage than expected. Because the sternum is sunken in, it doesn't take much volume or projection for them to have deeper cleavage.
• Flat sternum — A neutral starting point.
• Pectus carinatum (protruding sternum) — The opposite effect. It takes more projection and volume for these patients to see cleavage.

Chest wall tilt: If your rib cage is tilted outward rather than flat, you often won't get as much cleavage as you'd want — even with larger implant placement.

Everybody has their own unique mix of breast tissue and fatty tissue. Women with more dense breast tissue tend to have more projection — the breast sticks out more. Women with fattier breasts tend to have less projection, where the breast sits closer to the chest.

So if your breast tissue is more dense, you'll usually get more cleavage even with smaller implants than a patient who has fattier breasts.

When you're going into an augmentation, it's really important to relay your goals to your surgeon. Almost every augmentation patient wants better cleavage — and you need to have a frank, honest discussion about what your anatomy looks like and what they think your outcome is going to be.

If you decide you want to use a higher profile implant — say you have pectus carinatum or a tilted chest wall — it's really important to understand what that means. The implant we're going to place will be larger in order to fit your chest wall. And that might give you a new problem: you might have the cleavage you like, but you could end up top heavy and too big to fit in your clothing.

Always talk about these things with your surgeon. There are so many different variables with anatomy and breast augmentation. It's not as simple as just slipping an implant in.