Symmastia Repair

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Revisionary breast surgery is commonly performed at Pousti Plastic Surgery. For patients with malposition of the breast implants, it is very important that they have a qualified surgeon performing their revision. Medial displacement of breast implants is known as symmastia. This is commonly referred to as "breadloafing" or "uni-boob".

This results from the loss of tissue support along the sternal area, allowing breast implants to move excessively towards the woman’s midline. If the pectoralis 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 chestwall anatomy trying to increase cleavage in 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 submuscular implant placement allows the muscle to provide some softening of the transition to the cleavage area from the augmented breast mound.

The degree of medial displacement varies from patient to patient and the reconstructive technique therefore, also varies. Usually, the medial displacement of the breast implants causes the nipple-areola complex to appear off-center on the patient’s breast mound. Often, there are other problems associated with the symmastia including “bottoming out” (inferior displacement of the breast implants), rippling / palpability of breast implants and breast asymmetry.

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.

For correction of symmastia, the procedure can take from 2-3 hours depending on how much work is involved.

  • An incision is made (usually under the areola) to expose the underlying tissue, muscle, and implant.
  • The tissue that surrounds the implant is removed in the area of the planned repair.
  • Tissue is sutured together to hold implant in place (with permanent sutures).
  • The incision is then sutured close.

Intra-operatively, sitting the patient upright is imperative to assess the repair and degree of symmetry. Patience is important as multiple trials of suturing may be necessary to achieve satisfactory repair and symmetry.

Post-operatively, the use of tape is used to apply pressure on the previously elevated skin overlying the sternum. Compressive dressings and a pressure bra are also helpful.

What To Expect After Surgery

Bed rest, along with plenty of fluids, is necessary after surgery. Your chest will be sore. I will prescribe appropriate pain management medications. Take your medication regularly and keep your office visits. Usually after a week, you will begin to feel back to normal.

A brassiere and bandeau will be fitted for you during your first week of recovery. These will need to be worn for a month. You will not be able to shower until your sutures are removed. Initially, breast implants will appear to be slightly higher than normal and your breasts will be swollen. Over time, the breast implants will descend to a more natural position.

The bra that is worn after symmastia repair is referred to as the "thong bra". It is used to stabilize the area after symmastia reconstruction. This will allow the sutured area between the breasts to heal properly without excessive pressure being applied to the area.

Article by
San Diego Plastic Surgeon