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Topic: Aesthetic Surgery of the Breast

Cleavage classification: categorizing a

vital feminine aesthetic landmark

Muhammad Adil Abbas Khan , Ammar Asrar Javed , Nigel Mercer 3
2
1
1 Plastic Surgery, NHS Lothian, Edinburgh EH1 3EG, UK.
2 Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
3 Plastic Surgery, Bristol Plastic Surgery, Bristol BS1 4LF, UK.
Address for correspondence: Dr. Ammar Asrar Javed, Department of Surgery, Johns Hopkins Hospital, 600 N, Wolfe Street/Blalock 611,
Baltimore, MD 21287, USA. E-mail: ajaved1@jhmi.edu.

Breast cleavage is defined by the International challenging position when the patient’s expectations are
Federation of Associations of Anatomists (IFAA), as the not realistic; therefore a strong communication of ideas
[11]
space present between a woman’s breasts. The width is necessary. Titration of the subjective expectations
of the inter-mammary cleft is defined by the distance of the patients, while aiming for satisfactory aesthetic
between the points of attachment of the breast tissue to outcomes, becomes a dilemma for the surgeon.
the periosteal tissue. [1-3]
It is therefore important to devise a more objective
Cleavage is associated with femininity and its exposure method of assessing the preoperative anatomy and
to varying degrees by women across the world can classifying the postoperative expectations of a woman
be aimed to heighten both self-image and physical wanting an augmentation. Much work has been done
attractiveness. [4,5] The use of Décolletage in dresses dates to classify breasts based on their shapes, contours and
back to the 11th century, when an aesthetic cleavage sizes; [12-15] however, despite cleavage being an equally
was perceived as a sign of beauty, wealth and social important determinant of one’s beauty, there has not been
stature. [6,7] Corsets were later introduced in the 16th any reported efforts towards classification of cleavage. [16]
century and their use was primarily aimed at pushing
the breasts upwards to give a fuller cleavage. [8,9] In more Body postures, alternate postures, bras and garments
can influence the appearance of the cleavage and hence
recent times, specialized brassieres (push-up bras) with during the assessment stage, a female patient’s natural
various forms of paddings (falsies) have become the more cleavage shape should be assessed in the ‘‘neutral’’
popular and comfortable option. Other conservative position with her arms by her sides and her hands on
methods of making the cleavage more prominent include the back as she slightly leans forward. We identified
skin pulling techniques, taping, use of glued shapes, different shapes of cleavage that women present with
under bras, adhesive gels and the use of makeup. and classified them based on the ‘‘anterio-posterior’’ or
‘‘frontal’’ view (surgeon’s perspective and patient’s mirror
Breast augmentation is the most commonly performed view) as well as a ‘‘cranio-caudal’’ or ‘‘bird’s eye’’ view
cosmetic procedure in the US, and in recent years a (patient’s direct visual perspective).
great increase has been reported in the number of these
[10]
procedures performed annually. Women requesting ANTEROPOSTERIOR OR FRONTAL VIEW
breast augmentation often request a specific form of
cleavage enhancement and it is common for potential From a frontal perspective, the shape of the cleavage has
patients to bring photographs of desired cleavage shapes
and appearances. A plastic surgeon can be put in a This is an open access article distributed under the terms of the Creative Commons
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How to cite this article: Khan MAA, Javed AA, Mercer N.
DOI: Cleavage classification: categorizing a vital feminine aesthetic
10.20517/2347-9264.2015.84 landmark. Plast Aesthet Res 2016;3:36-8.
Received: 13-08-2015; Accepted: 24-11-2015
36 © 2016 Plastic and Aesthetic Research | Published by OAE Publishing Inc.