Many times, patients come to my clinic and the first thing they complain about is seeing pictures online where some patient has an extremely large gap between the breasts. They criticize that surgeon for what they consider a less than satisfactory outcome, but I can tell you that the gap between the breasts has nothing to do with the surgeon and everything to do with the patient’s anatomy. If you look closely at a patient who has a gap between the breasts, they had this gap prior to the surgery. The origin of the breast starts significantly away from the midline, and when you insert an implant, it is placed at the center of the breast, from the origin of the breast all the way to the lateral fold of the breast. The surgeon cannot cut away your whole breast and move it to the side so you can have cleavage after surgery. If you attempt to create cleavage during surgery, you can get into significant problems with what we call symmastia: both breasts will be connected through the midline and the implants will be displaced toward the midline, creating the look of three breasts instead of two.Let me show you a patient with a gap before surgery and how the gap still shows after surgery. If I draw a line through the origin of the breast and put a circle where the implant is going to be located, you can see that the patient will have a gap after surgery. Now let’s take a look at a patient whose breasts were close together before surgery; after the implants, she developed nice cleavage with absolutely zero effort from the plastic surgeon. So, if you have a gap between your breasts, there is actually a good solution for you, and it is called Victoria’s Secret. That is what a bra is about. You put on a bra, you are going to have cleavage. Most people do not walk around nude showing their breasts to everybody.You need to understand the limitations of surgery. If a surgeon attempts to detach the origin of the pectoralis major muscle in those patients with a large gap, this can create what we discussed before: a problem that will be very difficult to correct. As you can tell from what I described, creating surgical cleavage is not a good surgical practice. Be realistic about what you are going to get from the surgery and what you are trying to achieve. Take a look at your breasts before surgery and where the breast origin starts. You can draw a line and see before surgery how big the gap will be after surgery. By understanding your breasts and your breast anatomy, you will recognize that creating surgical cleavage is not going to be possible.