The patient is a young woman who has breast augmentation. Large implants are chosen to maximize her size as well as distribute her dense breast tissue. The patient is happy with her resulting cleavage, but this is secondary more to her chest structure than to the implant size. Implants may be only be properly placed as far medially as the insertion of the pectorais muscle into the sternum will allow. If these insertions are released or tear, symmastia (where the implants touch in the center and have no definition) can occur. This is a very difficult problem to improve upon. A relatively narrow sternum, level chest shape, pre existing soft tissue with inframammary folds curving towards the midline, and a larger implant all contribute to cleavage. Women without these factors will not develop cleavage (without the aid of a good bra), no matter how large the implant.