Q: I am 38 years old, have breast fed two children and definitely sag some. While I never had big breasts, they have now completely gone away! My bra size is 34A. In addition, I have a wide sternum and my breasts appear to be fairly far apart. I think a good breast implant size for me is around 350cc. In order to get cleavage, should the implant be placed above or under the muscle?
A: While implants do a wonderful job of making breasts larger, they do not usually result in cleavage on their own. With widely separated breasts, cleavage will definitely not result from the placement of any reasonably-sized breast implants whether they are placed above or below the muscle. At 350cc, a moderately-sized implant for your chest, cleavage is not a realistic possibility. Trying to make cleavage by going above muscle with your small breast volume is a mistake in my opinion. The implant is at much great risk of hardening over time (capsular contracture) and runs the risk of resulting in synmastia (the joinging of the two breast pockets in the middle, a uni-breast so to speak), which is a very difficult problem to correct. Settle for the better long-term breast augmentation result of under the muscle and accept that cleavage without a bra is not a possibility with your breast/chest anatomy.
Dr. Barry Eppley