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I Had BA Surgery One Year Ago and Ended Up with Symmastia, Severe Muscle Distortion and Possibly Bottoming Out - Any Advice?

asked 1 year ago by Detroit1152 in Detroit, MI
Latest answer by Jaime Perez MD
Question viewed 1,870 times
Tags: waist, bottom out, distortion, revision, symmastia

Pre-Op I was a very small 32AA-left breast was smaller and higher than the right. Post-Op 32C-300 cc saline submuscular. Nervous for revisionary surgery-None of my problems are even anywhere close to being a permanent fix. Switch to over muscle, internal sutures, change to smaller silicone, Possibly just remove implants? Trust my PS?-He seems shocked that this happened. Could I end up in a worse position after revision? Any advice would be appreciated.

20 answers to I Had BA Surgery One Year Ago and Ended Up with Symmastia, Severe Muscle Distortion and Possibly Bottoming Out - Any Advice?

+3

PHOTOS: Double bubble, bottoming out, synmastic ("uni-boob")

There are so many separate conditions that it would be difficult to fix in one stage. However, if this were your wish I would consdier a neopectoral pocket with dual plane dissection and smaller implants with possible radial relaxing incisions or fixation of the IMF with Acellular Dermal Matrix after a thorough discussion.
Otto Joseph Placik, MD

Chicago Plastic Surgeon
+2

Treating symmastia may require the use of Strattice

Bottoming out of breast implants usually requires removal of the implants, tightening of the pocket underneath with stitches, and replacement of the implants.  For the symmastia, Strattice is a xenograft piece of tissue that can be used to "wall-off" the middle of your chest in order to prevent the implants from moving together.  The pocket tightening and Strattice placement can be done at the same time as an outpatient procedure.  Good luck!
Jeffrey E. Schreiber, MD

Baltimore Plastic Surgeon
+2

Symmastia after breast augmentation

Although uncommon, symmatia can occur after breast augmentation.  Your implant diameter is too wide; and your implants are too close together.  I would use a smaller implant and utilize Alloderm (acellular dermal matrix) as a sling medially to give support.  It is a challenging problem to correct; however, it can be done.  
Sugene Kim, MD

Houston Plastic Surgeon
+2

Synmastia Treatment

It is difficult to assess your problems from the quality of your photos.   There seems to be multiple issues going on here.   I will address the synmastia.  Synmastia is a challenging problems to fix. Synmastia clinically manifests as a "uni-breast" where the cleavage (space between breasts in the area of the chest plate) has been lost. Anatomically, usually it is because the medial aspect of each breast pocket has been over dissected or stretched... more
C. Bob Basu, MD

Houston Plastic Surgeon
+2

Asymmetric breasts after breast augmentation

There are a number of issues evident from you photo. Muscle activation distorts the breasts, the implant base diameters are too large for your chest/rib cage size, the nipple complexes are both too far from the midline, the inframammary folds are both too low so the implants are not centered under the nipples (even if the nipples were in the proper position).  You may keep the same size of implant in terms of cc but you will need to get implants with smaller base diameters. You... more
Aaron Stone, MD

Los Angeles Plastic Surgeon
+2

When breast implants are just not working out, symmastia

With a multitude of problems after breast augmentation such as low pockets and implants that run together in the middle of the chest, symmastia, it is very understandable that you cannot trust your plastic surgeon. I feel the best choice is to remove the implants and let your chest and breast fully heal and recover, and consider replacement at a later date when shaping the pocket and positioning the implant become more predictable. Sad to start over but your present situation is dreadful... more
Peter E. Johnson, MD

Chicago Plastic Surgeon

www.peterejohnsonmd.com

+1

Breast Augmentation with Symmastia, Muscle Distortion, and Bottoming Out

Hello, I'm sorry that you've experienced these complications following your breast augmentation. However, each of these issues can be improved, but will, of course, require revisionary surgery. 1. Symmastia- symmastia, or "uniboob" can likely be corrected by placing your implants in a new plane (in your case, above the muscle or above the muscle but under the muscle fascia). Using a smaller implant with a smaller base diameter will decrease... more
Jaime Perez MD

Tampa Plastic Surgeon
+1

Symmastia surgery

Symmastia (medial malposition breast implants) can be corrected with high likelihood of success using medial breasts implant pocket sutures (medial capsulorrhaphy), lateral capsulotomy (if necessary), and/or the use of allograft. I do not believe that a staged procedure, involving removal of implants for period of time, is necessary. There is a learning curve with this operation and I recommend that you seek consultation with a board-certified plastic surgeon with significant... more
Tom J. Pousti, MD

San Diego Plastic Surgeon

www.poustiplasticsurgery.com

+1

Breast implant revision

Many of the recommendations provided are good to consider. Give thought to obtaining a 2nd or 3rd opinion. Ask about costs of revision as some of these options require additional costly materials (AlloDerm and similar products). Based on what you describe, your surgeon may want to consider making a new pocket for the implants above the muscle and place smaller silicone gel implants.
Karol A. Gutowski, MD

Chicago Plastic Surgeon
+1

Revision surgery is needed.

I don't agree that your implants are too large for your chest having caused this problem.  A revision surgery is needed to separate the 2 pockets but I think you can still pick how large you would like your breasts to be.  This is an unfortunate problem you have, but don't loose hope - it can be repaired.  Good luck!
Bivik Rajnikant Shah, MD

Columbus Plastic Surgeon
+1

Breast issues

While I can make out a few things on the photos, some are quite dark.  More than likely you will need to have smaller implants and then capsule work to close the pockets especially medially to eliminate the symmastia. Sometimes alloderm works well here.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Revision of my breast augmentation surgery

I would agree with the previous physicians.  This can be a very difficult situation to fix and so keeping the repair simple is probably the best suggestion.  I too would either drain or remove the implants for a few months and allow the pockets to heal down.  Following that, I would use Strattice or Alloderm along with internal retention sutures to recreate the pocket both inferiorly as well as medially.  Speak with you plastic surgeon about these options and... more
Gregory A. Buford, MD

Denver Plastic Surgeon

www.beautybybuford.com

+1

Correction of multiple breast problems.

There are several differant options to address your problems, but I've always felt the simplest is the best.  I would favor removal of both implants (simple, can be done under local anesthesia) and allow several months for the internal tissue to heal.  Then you could redo the augmentation with smaller implants, in a differant plane and a carefully dissected pocket.  While placing internal sutures, or suturing a repairing sling are possible, there can be problems and costs... more
Jeffrey M. Darrow, MD

Boston Plastic Surgeon
+1

Symmastia

Yes, this is an unusual problem with breast augmentation.  Basically, the implants are too large and the pockets are too close.  The advice that others have given is correct.  The current implants either need to be internally drained or removed and the pockets allowed to constrict.  After 3 to six months, the implants can then be replaced with small volume implants.  Additional stitches or possibly an alloderm product may need to be sutures in the medial edges of the... more
David Shafer, MD

New York Plastic Surgeon

www.ShaferPlasticSurgery.com

+1

I Had BA Surgery One Year Ago and Ended Up with Symmastia, Severe Muscle Distortion and Possibly Bottoming Out - Any Advice?

Very hard to correct but the photos are excellent. My choice is going above with Alloderm sheet and retension sutures in the sternal area. Best of luck from MIAMI Dr. Darryl j. Blinski
Darryl J. Blinski, MD

Miami Plastic Surgeon
+1

Symmastia and severe muscle distortion after augmentation.

Thank you for the photos. Several different suggestions were made to correct your problem (which is a difficult one). The good news is that you have saline implants! My approach to your problem is a simple one. Have your surgeon stick your implants and have them deflated (avoids one complex operation with internal suturing, placement of strattice or other compounds, etc.). Your surgeon can go back in 6 months, pull out the shells and place new, smaller silicone gel implants in a neo-pocket.... more
George Marosan, MD

Bellevue Plastic Surgeon

www.bellevueplasticsurgeons.com

+1

Repair of symmastia, animation deformity and double bubble: Strattice

Fortunately there is a very elegant and effective solution for your difficult combination problem, unfortunately not every plastic surgeon has the experience to correct it. (I don't know if yours does or not.) Switching to over the muscle will help with some of the issues but not necessarily all, and will leave less implant coverage and support. A Strattice graft will treat all of the issues. I would encourage you to look into that and be sure you understand the options, since once a... more
Richard Baxter, MD

Seattle Plastic Surgeon
+1

Correction of Symmastia (Uni-Boob)

Regarding:"I Had BA Surgery One Year Ago and Ended Up with Symmastia, Severe Muscle Distortion and Possibly Bottoming Out - Any Advice?   Pre-Op I was a very small 32AA-left breast was smaller and higher than the right. Post-Op 32C-300 cc saline submuscular. Nervous for revisionary surgery-None of my problems are even anywhere close to being a permanent fix. Switch to over muscle, internal sutures, change to smaller silicone, Possibly just remove implants? Trust my PS?-He... more
Peter A. Aldea, MD

Memphis Plastic Surgeon
+1

Correcting symmastis is tough

Symmastia is one tough problem to fix, better prevented than repaired.  But if you have it, it sounds like you know the options plus possibly Strattice.  In my opinion, either switch the pocket and go smaller and narrower with the implant or take them out and heal for 6-9 months and start over.  NEVER TRY TO WITH A BIGGER IMPLANT!!
Richard P. Rand, MD, FACS

Seattle Plastic Surgeon
+1

Really distorted breasts with big submuscular saline implants- Was it Predictable? ( or not?)

First, sorry to those women who got what they asked for instead of what would work best for their body shape and size.   Remember, breast augmentation is NOT an easy operation.  You have to be FITTED for a breast implant that will work properly  for your actual breast/chest size and shape.  You CAN'T have any size you want, you can ONLY HAVE A SIZE THAT FITS YOU (sorry for shouting there).    There is a range of devices that will properly fit a given... more
Claudio DeLorenzi, MD

Toronto Plastic Surgeon

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