Hello, I am 29 years old, my height are 1,73 cm and I weight today 62 Kilogram (before the breast Augmentation I weighed 50 Kilogram). I had in 2007 a Breast Augmentation but I´m not very happy with the results. My Breast are too close together (no space between them!). I have high profile silicon implants in 380 cc. I´m going to change the Implants in April 2012 and I will like they bigger. What can I do or what the doctor should so that the results will be better (more space between them?
Breast Implants Too Close Together - What Has Gone Wrong?
Doctor Answers 13
Breast implants too close together
In my opinion, the implant used for your augmentation was too wide for the width or your breast and the pocket to place it was created far too medial (to the center) such that the implant is centered to the medial side of the nipple-areola and there is borderline or true symmastia (connection between the breasts).
It is very difficult to correct this, but the only option short of a full correction with dermal matrix grafting or a new implant pocket is to try to expand the lateral width of the breast and/or use a slightly smaller diameter implant. Trying to use a larger implant will aggravate the problem. This is another reason why it is so important to use a properly sized implant for the initial operation, get it positioned properly, and get it healed there.
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Breast Implants Too Close Together - What Has Gone Wrong?
You are a 50Kg woman who after augmentation with way too large/wide implants weighs 12 Kg (26.4 pounds) more. Your implants, if they were 380cc weigh only 0.74Kg (or 1.6 pounds) but it is obvious that your chest wall was TOO narrow to accomodate them and the surgeon overly dissected the inner pockets resulting in "kissing implants", aka cyclops breasts or uniboob or Symastia.
Your stating "I will like they bigger" partially explains why the surgeon put in implants he should not have. The solution here is NOT to go bigger but to go smaller with implants which fit the size limitations of your chest wall and to try and repair the inter breast pocket communication which is not easy to do.
Breast implants are too close together
If the pocket is not centered in the breast, or the implant is too large for the skin envelope, the breasts may run together in the center, called symmastia. Once the implants lift the skin in the mid chest it can be very hard to correct, and a larger implant is likely to make matters much worse. If you are lucky, a smaller submuscular implant can improve things.
Best of luck, peterejohnsonmd.com
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Breast Implant Malposition (Symmastia)?
Thank you for the question.
Although it is not clear that you have true symmastia you definitely have medial breast implant malposition.
Symmastia (or medial malposition or “uni-boob”) occurs when the breast implants move too far toward the midline--the two implants may actually touch one another in the center of the chest. If the horizontal muscle that is connected to the sternum and goes across the implant is cut during surgery, then the implant can move toward the middle of the chest.
Symmastia may result from overly aggressive attempts to alter chest wall anatomy trying to increase cleavage for patients. This outcome is made worse by use of larger implants in thin patients, and is a problem for implants over or under the muscle, though sub muscular implant placement allows the muscle to provide some softening of the transition to the cleavage area from the augmented breast mound. Correction involves use of internal sutures of the capsule around the breast implants. Often, it is necessary to expand the breast implant pocket laterally (outwardly) to allow for correct placement of the implants.
Correction of symmastia involves careful planning and intra-operative reinforcement of the medial fold of the breasts. Reconstruction usually involves removal of the breast implants and internal suture reinforcement of the involved area. The use of dyes and needles through the skin surface assists the exact placement of permanent sutures. Usually the breast implant capsule that is redundant is removed to allow for two raw surfaces to heal together, presumably lowering the rate of recurrence of the symmastia.
Often, it is necessary to “open” the breast implant pocket laterally (outer breast fold) to allow for positioning of the implant centrally behind the breast mound. This maneuver may also decrease the amount of implant pressure against the medial suture line. Use of a smaller breast implant, if possible, may serve the same purpose.
Correction of implant malposition issues does require some experience; make sure your plastic surgeon can demonstrate his/her experience level.
Symmastia versus too large implant
It is difficult to tell whether or not you have symmastia, but I would be careful about rushing towards larger implants as they will quite possibly make the problem worse. You might be better off getting this chest problem fixed first. You need a good second opinion by a local qualified plastic surgeon.
John Di Saia MD
It looks like you have a symmastia. This happens more commonly when implants are placed above the muscle or if the muscle fibers are divided in the midline. Going with larger implants is probably not a good idea. You may even need a pocket change or strattice placed to adjust the pocket.
You can't go larger when you have symmastia
The natural separation between your breasts has been lost causing a symmastia (unibreast) deformity. These are a challenge to fix and much depends on whether they are above or below the muscle which you didn't mention. Acellular drmal matrix material can also help here.
The main thing is that trying to go larger (this means even wider implants if you are already high profile) will dramatically increase the risk of failure of repairing the symmastia. If anything, to increase the chance of success, you actually would be wise to go smaller and narrower.
I would not reccommend larger implants
The implants that you have are already probably too large for your body. If you go larger it will only exacerbate the issue. I agree that using Acellular dermal matrix to reinforce the medial pocket would be a good idea along with using a smaller implant to fit the width of your chest wall.
Looking at your photohraphs, it appaers to me that you have capsular contracture laterally and inferiorly. Capsulotomy to release the tightness and increasing the pocket size will help to relocate the implants and certainly some support medially will also contribute to a better outcome. I strongly caution not to go any bigger as that will defeat the purpose of increasing the pocket size.
Breast implant pockets can be separated with internal sutures or with Alloderm.
The implants are too close together, and they make your nipples point outward towards your arms. At the time of your surgery, the implant pockets were dissected too close to each other. Now, the inner edge of the implant pockets needs to be closed off, and the pockets need to be enlarged on the outside. This can be done reliably.