A number of my patients coming in for plastic surgery in Phoenix have recently asked me the same question, so I felt like I should address it on my blog. The question was a variation of: “Why do I see some women walking around with a wide, unattractive gap between their breasts?” Cleavage is an important issue for patients, and in my opinion, there are three main causes for an excessively wide spacing between the breasts after surgery.
The first and most significant factor is patient anatomy. Each woman has a unique natural spacing between her breasts, which also corresponds to where the pectoralis muscles attach to the sternum (breastbone). Some women have a flatter ribcage, while others might have more bony projection, less projection with an inverted sternum (pectus excavatum), or asymmetry. Anatomy is hard to completely change, and it has a major impact on the final results of surgery. That being said, a good breast surgeon will notice preexisting issues and will do whatever is possible to correct them. For example, patients with wide attachments between the chest muscles need a more aggressive dissection to move the implants as close together as the anatomy will allow safely.
A second factor is implant selection. Implant width should generally match the patient’s base width diameter (the natural width of the chest where the implant will be covering). Implants that are too narrow or too projected can exaggerate the appearance of wide cleavage. There are many implants available with different widths and projections. Newer implants, such as Sientra’s textured anatomical “gummy bear” implants can also be used to create a more natural cleavage for women with particularly wide or narrow breast widths. Surgeon experience and preoperative measurements and sizing can help get the best possible results for patients.
Finally, surgical technique is an important factor in the final cleavage. Underdissection, incomplete release of the lower pectoralis attachments, or failure to account for tight lower breast skin or tuberous breasts can all result in an unacceptably wide spacing between the breasts. As with implant selection, a surgeon’s experience with a large range of patient body types is critical in achieving a beautiful and natural cleavage.