The Beauty Standard with Dr. Roy Kim

The Cleavage Dilemma What Patients Want vs. What’s Possible

• Dr. Roy Kim

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The disconnect between patient expectations and surgical realities of cleavage in breast augmentation can lead to confusion and disappointment. Dr. Roy Kim explains the difference between the close-together look patients desire and the medically appropriate intermammary distance surgeons aim for.

• Surgeons measure "intermammary distance" and aim for about 2cm of space between breasts
• Breasts that naturally touch (symmastia) is considered a complication, not an ideal result
• Your natural anatomy, especially rib cage width, significantly impacts what's possible
• Implant profile choice affects how full the upper breast appears
• Fat grafting can help create smoother transitions and bring breasts closer together
• Supportive garments (bras, structured clothing) dramatically change cleavage appearance
• Bring inspiration photos to consultations to communicate your goals clearly
• The "perfect cleavage" seen in media often relies on supportive garments, posing, and editing

Do your homework, bring inspiration photos, be honest about your clothing habits, trust your surgeon's expertise, and ask questions until you feel confident in your understanding of what's possible for your body.


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Speaker 1:

Welcome to the Beauty Standard with Dr Roy Kim. Hello and welcome to the Beauty Standard podcast. I'm Dr Roy Kim, a plastic surgeon in San Francisco and Beverly Hills. Today we're tackling a topic that comes up in almost every breast augmentation consultation cleavage. But here's the twist what you think of as cleavage and what your plastic surgeon thinks of as cleavage might not be the same thing. So how do you make sure you get the look you want and what's actually possible based on your anatomy? Stick around, because I'm going to break it all down and give you the inside scoop on how to talk to your surgeon, set realistic expectations and get the best results. Let's start with the basics. When most patients come to see me and talk about cleavage, they're usually thinking about two things how close their breasts are together and how full the upper part of their breasts looks, especially in certain outfits. But as a plastic surgeon, I'm using a different set of terms and measurements. For us, it's all about something called the intermammary distance, that's, the space between your breasts, and, believe it or not, surgeons actually don't want your breasts to touch. Naturally. If they do, that's called semastia, which is actually a complication, not an ideal. So why the disconnect? Well, it comes down to anatomy, surgical technique and, honestly, a little bit of fashion magic. Today I'll explain how all these factors come together, why communication is key and how you can make sure you and your surgeon are on the same page. All right, let's dive a little deeper.

Speaker 1:

First, let's define what we're really talking about when we say cleavage. For most patients, cleavage is about that attractive, close-together look, maybe even some fullness at the top, what we call the superior pole of the breast. You might be picturing yourself in a dress or swimsuit where your breasts look full and sit close together. That's the look right. But for plastic surgeons we're looking at things a bit differently. We measure the intermammary distance, the space between the breasts at the chest wall. We want that space to be close, but not so close that the breasts are touching naturally. If they're touching without any support, like a bra or a dress, that can actually be a sign of a problem, specifically semastia. That's when the tissue between the breasts is disrupted and, trust me, it's not something you want. So what's normal? Most plastic surgeons aim for about 2 centimeters of space between the breasts, maybe a little more depending on your body. But here's the thing Most patients want their breasts. The breasts maybe a little more, depending on your body. But here's the thing Most patients want their breasts even closer maybe less than an inch or about 1 to 1.5 centimeters. It really depends on your rib cage, your natural anatomy and your aesthetic goals. And here's where things get interesting. Your bone structure, your rib cage and the width of your chest plays a huge role in what's possible. If you have a wider chest, it's going to be harder to get that super close cleavage without running into problems. If you have a narrower chest it's a little easier. But as always, safety comes first.

Speaker 1:

Now let's talk about breast implants. The type of implant you choose can make a big difference in how your cleavage looks. Implants come in different profiles moderate, demi, high profile and so on. The profile refers to how much the implant projects from your chest wall. Higher profile implants are a bit thicker and can give you more fullness at the top of the breast, which can help create that cleavage effect. But it's not just about the implant how much natural breast tissue you have and whether you add fat grafting on top also plays a role. Fat grafting is when we take a little fat from another part of your body and inject it around the implant to add volume and smooth things out. This can help bring the breasts a little closer together, but again, we're aiming for close, not touching.

Speaker 1:

Here's something that often gets overlooked the role of supportive technology. I'm talking about underwire bras, push-up bras, even the structure of certain dresses. These can dramatically change the appearance of your cleavage. When I take clinical photos in my office, there's no support, just you, your implants and gravity. But when you put on a bra or a dress with built-in support, everything gets pushed up and in creating more dramatic cleavage. So when you're thinking about your goals, consider how you want your breasts to look, both with and without support. Do you want a natural look when you're wearing a t-shirt or are you more concerned about how things look in a formal dress? These are important details to discuss with your surgeon.

Speaker 1:

Now let's talk about how to make sure you and your surgeon are on the same page. One of the best things you can do is bring in inspiration photos, show your surgeon what you like and what you don't like, be specific about the look you're going for and ask your surgeon to explain what's possible based on your anatomy. And don't be shy about asking questions If you're not sure what a term means, or if you're confused about something, speak up. Your surgeon should be able to explain things in plain language and help you understand your options. Here's the reality. Not everyone can have the same cleavage as a Victoria's Secret model, and that's okay. Your anatomy, your skin, your rib cage all of these things play a role in what's possible.

Speaker 1:

The goal is to get as close as possible to your ideal while keeping things safe and natural looking. Sometimes patients come in wanting their breasts to touch but, as I mentioned earlier, that's not actually a healthy or natural result. A little space is normal and, honestly, it looks more natural. So what can you do to get the best results? 1. Do your homework. Look at before and after photos, both with and without support, to get a realistic idea of what's possible. Two bring inspiration Photos. Visuals are incredibly helpful for communicating your goals. Three be honest about your habits. If you love wearing push-up bras or certain styles of clothing, let your surgeon know. Four trust the process. Your surgeon's job is to balance your goals with what's safe and realistic for your body. Five ask questions. Don't leave the consultation until you feel confident you understand your options. You know, after more than 25 years in practice.

Speaker 1:

I've seen a lot of trends come and go, but one thing that never changes is the importance of clear communication. Patients are often surprised to learn that the perfect cleavage they see online is usually the result of a great bra, some clever posing and maybe a little Photoshop. In real life, natural-looking, healthy cleavage is about balance between your anatomy, your goals and what's surgically safe and just between us. Sometimes the best results are the ones that look great in a t-shirt and even better when you dress up for a night out. So, to wrap up, getting the cleavage you want after breast augmentation is all about understanding the difference between what you see and what's surgically possible.

Speaker 1:

Talk openly with your surgeon, bring in inspiration photos and be realistic about your goals. Remember a little space is normal and healthy. Here's my question for you what's your ideal look and how do you communicate that to your surgeon? I'd love to hear your thoughts. Thanks so much for tuning in. If you found this episode helpful, check out my other podcasts for more insights on plastic surgery and beauty trends and, as always, take care of yourself and have a great day. Thank you for listening to the Beauty Standard with Dr Roy Kim. Make sure to follow for future topics and episodes.