Can I Go Bigger in Symmastia Revision?

i went to 2 surgeons for opinions on my symmastia , one told me that i should decrease to 300cc and go under muscle with intenal sutures, the other told me that i can go up to 600cc above muscle with intenal sutures, also told me i can go to any size i want, both are members of ISAPS. please need advice currently 325 above musc.

Doctor Answers 8

Symmastia and Breast Implant Sizing

In general it would best to decrease your breast implant size when undergoing symmastia repair.  It is best to discuss your options and surgeon preferences during your consultation.

Philadelphia Plastic Surgeon
5.0 out of 5 stars 17 reviews

Can I Go Bigger in Symmastia Revision?

    As someone who repairs symmastia fairly frequently placing a larger implant in the same pocket is putting you at a higher risk for recurrence.   Strattice or another dermal matrix can reduce this risk but will not eliminate this, and the product significantly increases the cost of the revision.  When the pocket is changed to a submuscular pocket, the size increase may be less of an issue.  Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast augmentation revisions each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Synmastia generally indicates placement of smaller implants at the time of repair.

I agree with switching the implants to a new pocket if you indeed have synmastia. I don't think larger implants are probably a good idea but there really is no absolute contraindication to it.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

Implant diameter more important than size for symmastia repair

If implants are over the muscle, going under will be a very good option to correct symmastia. However, regardless of technique, if the implants are too large in base diameter then there will be stress on the repair and it will have a high chance of relapse. The largest size will be high profile in the diameter that matches your measured anatomic base diameter. Other options useful for symmastia are acellular dermal matrix grafts such as Stratttice.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 54 reviews

Typically not a Good Idea to Go Bigger in Symmastia Revision

Without more information, it is hard to give specific comments. However, putting larger implants in at the time of a symmastia repair is generally NOT a good idea. The repair is less likely to be successful. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 69 reviews

Symammia difficult to correct

Unfortunately, symammia or symmastia is difficult to correct.  I would try to avoid going bigger as this puts more stress on the repair.  I do believe that a new pocket (under the muscle if they are over) gives a much better chance of success and possibly the use of acellular dermal matrix to support the medial chest.  If you are 325 now you can probably stay the same size as long as the lateral pocket is of adequate size.  Good luck.

Steven Schuster, MD, FACS
Boca Raton Plastic Surgeon
4.0 out of 5 stars 8 reviews

Symmastia Correction and Breast Implant Size?

Thank you for the question.  When it comes to revisionary breast surgery, there are no black and white answers that make sense for every patient. In other words, there is no way to know, without direct physical examination, whether your tissues will accommodate a larger breast implant while the symmastia is being corrected at the same time. To say that smaller breast implants must always be used, is an oversimplification, in my opinion.  On the other hand, I feel strongly that it is important not to use breast implants that are too large for the dimensions of the revised breast implant pockets, once the symmastia has been corrected.

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 indicated, may serve the same purpose.

 Select your plastic surgeon carefully based on demonstrable ability to achieve the results you are looking for.  Ask to see lots of examples of their work and communicate your goals clearly.  At some point, hopefully you will be comfortable with the plastic surgeon's abilities and judgment.

 I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,501 reviews

Can I Go Bigger in Symmastia Revision?

It is hard to make a recommendation without photos. Most surgeons would hold that larger implants will increase the chances that the symmastia repair will fail, and would recommend smaller implants. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.