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Breast Cleavage Remodeling with Fat Grafting: A Safe Way to Optimize Symmetry and to Reduce Intermammary Distance

Serra-Mestre, José Maria M.D.; Fernandez Peñuela, Randolfo M.D.; Foti, Vanessa M.D.; D’Andrea, Francesco M.D., Ph.D.; Serra-Renom, José Maria M.D., Ph.D.

Plastic and Reconstructive Surgery: November 2017 - Volume 140 - Issue 5 - p 665e–672e
doi: 10.1097/PRS.0000000000003788
Cosmetic: Original Articles
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Background: In their descriptions of the ideal breast, most studies have focused primarily on the dimensions, shape, and proportions. The distance between the breasts has only very rarely been considered. The intermammary distance and the medial symmetry between the breasts are important parts of the outcome of surgery and have a strong bearing on patient satisfaction. However, the control surgeons have over these factors is only relative, and depends heavily on the underlying anatomical characteristics of the patients.

Methods: Eighty-six patients undergoing breast augmentation, breast reduction, or mastopexy and breast reconstruction with separated or asymmetric breasts underwent fat grafting in the medial quadrants. Intermammary distances were measured before fat grafting and 12 months later. Complications were also recorded.

Results: This technique obtained a statistically significant reduction in the mean intermammary distance (p < 0.0001) from 3 ± 0.6 cm (range, 1.6 to 5 cm) to 1.7 ± 0.4 cm (range, 1 to 2.8 cm) at 12-month follow-up. There were no major complications: one capsular contracture in a breast reconstruction requiring capsulotomy and an oil cyst requiring aspiration were reported.

Conclusion: The authors’ technique allows safe remodeling of the medial cleavage of the breast, reducing the intermammary distance and optimizing the symmetry between the breasts.


Barcelona, Spain; and Naples, Italy

From the Aesthetic, Plastic and Reconstructive Surgery Department, Hospital Quirón Barcelona; Universitat Internacional de Catalunya; and the Plastic and Reconstructive Surgery Department, University of Naples Federico II.

Received for publication January 17, 2017; accepted June 20, 2017.

Presented at the 48th National Meeting of the Spanish Society of Plastic Surgery, in Tenerife, Spain, June 5 through 7, 2013; I Conference on Body Conturing: Fillers and Implants, in Naples, Italy, May 21 through 22, 2015; and the National Meeting of the Spanish Society of Transfer Applications, in Barcelona, Spain, November 27, 2016.

Disclosure: This work received no financial support. The authors have no financial interest to declare in relation to the content of this article.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch. On the iPad, tap on the Hot Topics icon.

José Maria Serra-Mestre, M.D., Institute of Aesthetic and Plastic Surgery, Hospital Quirón Barcelona, Plaza Alfonso Comin, 5–7, Barcelona 08023, Spain,

©2017American Society of Plastic Surgeons