Tight cleavage is almost always a request from my patients here in Toronto. Unfortunately, when doing a breast augmentation, be it subglandular, subfascial or submuscular, there is a midline zone, over the chest bone (sternum) where we, plastic surgeons, must keep intact and refrain from detaching from the chest bone, the reason being the avoidance of a post-op complication called symmastia (literally meaning “one breast”). Think of symmastia as a “unibrow” of the breasts where the skin in the midline lifts up, either immediately after surgery or more commonly in the few months post-surgery with the use of the patient’s upper extremities such as a return to sports. It is therefore very important to avoid the excessive use of the pectoral muscles during breast augmentation recovery, as their contractions tend to push the implants towards the middle slowly lifting the central skin. For the same reasons, I ask my patients to avoid push-up bras initially post-surgery. The use of very large implants is also discouraged for the same reasons.
Symmastia is correctable but it is a more complex procedure that necessitates a return to surgery (and the associated costs) with a reopening of both pockets and the use of permanent sutures to close the inner pockets on each site.
So how do I provide my Toronto patients with beautiful augmented breasts with fuller upper poles and inner breasts for a tight cleavage without symmastia? With fat grafting. We call this CBA: composite breast augmentation.
Fat grafting areas for enhanced cleavage.
Prior to surgery, I mark on my patient an area of about 2,5cm centered on the midline where the skin will not be detached. This maneuver has allowed my patients (females and transgender females) to enjoy beautiful augmented breasts without symmastia. I also mark the donor sites where fat will be harvested, from areas of excessive fat deposits such as abdomen, flanks, bra rolls, outer thighs, inner knees, etc. Fat is cleansed and decanted and then infiltrated gently in multiple layers into the inner parts of the breasts to augment the area where the implants end – centrally but also in the upper poles as my patients always enjoy a fuller upper pole. I always use a “test implant” first to determine where the fat is needed as to not risk any contamination or injury to the real implants. I then draw the areas to be lipo-filled (fat grafted) – the deep subglandular plane (blue) and the more superficial subcutaneous plane (yellow). All healthy cells are transferred. As mentioned, I also take the opportunity to inject in the upper pole of each breasts as the upper poles never get as full as most patients would like with implants alone, even when using round implants. Gravity always leads to fuller lower poles.
Before and After- Fat grafting plus implants for breast augmentation.
CBA (composite breast augmentation) also allows me to recommend a slightly smaller implant to my patients which is beneficial long term (less stress on the skin envelop and subsequent sogginess aka ptosis). Issues in breast augmentation long-term is pre-surgical thin overlying tissues and then thinning of the soft tissues over time. The ratio of “pre-existing pre-surgical soft tissues” over “size of implant” is an important one – the higher the ratio is, the better it is for patients. So adding to the soft tissue with fat transfer and reducing the implant size will favour more successful breast augmentations over time. Plus, patients can benefit from a small liposuction at the same time!
This is how my Toronto breast augmentation patients can enjoy tight cleavage and a fuller, rounder upper pole without the risk of symmastia. To learn more about this technique, contact us online or by phone at (416) 929-9800 and schedule a consultation!
In the meantime, check out our photo gallery to see examples of real results.
Dr Marc DuPéré, aesthetic plastic surgeon
