Are my breast implants too close together? 6 months post op, concerned about possible symmastia (photos)

Question

I am 6 months post op from my breast augmentation and feel that my breasts are too close together and I may be developing symmastia. I received 385 HP silicone implants under the muscle. When I wear a push up bra you cannot notice but when I wear other types of clothing I feel that it becomes very noticeable. I am starting to be a bit self conscious about it and unsure on what to do.

Joe Gryskiewicz, MD, FACS · Answer

You should contact the surgeon who did your Breast Augmentation. It is possible you may need a revision, if not now then in the future. You should ask about intermammary compression exercises or other techniques recommended by your surgeon that may help.

Gianfranco Frojo, MD · Answer

I would recommend going back to speak with your original surgeon. It is difficult to determine if this is a true symmastia from the photos alone without a physical exam. It appears that you have a slightly level of symmastia but hard to determine.

Matthew S. Kilgo, MD · Answer

Based on your photographs, you still have some separation between the breasts, so technically you do not have symmastia. However, the breasts are very close together and I understand your concern. If you are unhappy with the results you might consider a revisional procedure. I would recommend smaller implants with a change of plane to a sub glandular, sub fascial, or neo sub pectoral pocket. I hope this helps.

Gerald Minniti, MD, FACS · Answer

Your pre-sternal skin is raised, your implants are touching or nearly touching, and that's symmastia. This is best fixed with a technique that re-establishes a new subpectoral pocket, as opposed to fixing the current pocket by capsulorrhaphy and mesh, which can fail and allow the implants to return back to the middle. Risk of failure increases with implant size when doing capsulorrhaphy and mesh, and your's are big for your anatomy. Neosubpectoral pocket creation allows the surgeon a 'fresh start' by dissecting your current capsule off of the underside of the muscle, creating new pockets that are farther apart (less dissecting in the midline, more dissecting laterally). Go to a Breast specialist!

Daniel Barrett, MD · Answer

Dear Witty684941,
I understand your concern. Based on your photos, it looks like you don't have symmastia. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Karl William Schwarz, MD · Answer

It looks like you don't have symmastia at this point, but rather just have implants that are very large for your breast. When an implant is too big for the breast the implant will start to steal skin from the surrounding areas to accommodate the implant. Your implants have taken most of the needed skin from the medial part of the chest thus giving you very, very close cleavage to the point where it does look a little un-natural. The nipple position starts to move towards the outside of the breast as they have done here as symmastia develops.

If you wanted to have cleavage as you had before than you would need to downsize your implant back to a size that fits within the breast itself and be an appropriate size so it doesn't need to steal skin. I would likely also perform a repair for symmastia even though it doesn't look like you have true symmastia but I would still close the pocket in the medial part to restore your cleavage to a more natural look.

I see this is Miami quite often as there is a real demand here for very large implants that don't fit the patient's breast.

Connie Hiers, MD, FACS · Answer

Your implants are too large and wide for your frame and tissue. I would suggest going down in width and size for a better fit. You may have some mild symmastia because of the size selected.

Camille Cash, MD · Answer

An exam is needed to know for sure but it does not appear from the photos that you have symmastia.  Your breasts are very close together which is probably related to implant selection.  If you are concerned you may want to exchange for smaller implants.

Mats Hagstrom, MD (license on probation) · Answer

Thank you for including quality before and after pictures.
Other patients should take note.
The outcome of breast augmentation surgery is usually based on three variables.
If patients are unhappy with the outcomes, then the problem can almost always be correlated with one or more of these three variables.
The variables that determine the outcome are patient candidacy, implant selection and the skill of the provider in regards to placing the implants in the correct anatomic location.
In regards to your candidacy for breast augmentation it was excellent.
Your breast are appropriately placed on your chest wall and have very little divergence.
They’re not excessively wide and you have good symmetry. By the way, it’s common for most people to have the left breast sit just slightly higher on the chest wall, then the right side.
Yours are pretty equal, but your left side is slightly higher, which as I mentioned is normal.
In many ways, you are the ideal candidates for breast augmentation.
 I think part of the problem with your outcome is related to implant selection and this is probably the number one reason your outcome looks the way it does.
Whenever implants are selected that are significantly larger than your natural breast diameter the chance of having undesirable side effects, complications or the need for revision surgery will always be higher.
 The implant has to go somewhere.
Perhaps your surgeon opened the pocket a bit much towards the midline, most likely to create a desirable aesthetic outcome.
This was in part needed because of the diameter of the implant.
Had you chosen smaller implants, especially a smaller diameter implant than the problem of fitting the implant under your breast, wouldn’t have been such a problem.
 Simply downsizing to a modest size implant will probably improve your outcome significantly.
If you really don’t want the implants as close to the midline as they are now, then it may require some revision work. Closing the pocket towards the midline. Without downsizing your implants, you’re going to continue having this outcome.
Implant selection is an important part of the process.
Each plastic surgeon will have their own way of guiding patients through the implant selection process.
Some providers ask patients to make the final selection in regards to the implant size. Another providers will make the decision based on input from the patient.
 Implant selection is really important and it is equally important that patients understand the consequences of choosing implants that are larger than your own natural breast diameter.
Some providers are better at guiding patients through implant selection than others.When it comes to having large implants, the expression “you can’t have your lunch and eat it too” comes to mind. Patients who desire large implants need to accept the fact that selecting large implants comes with problems.
Granted, sometimes the decision is made by the provider. 
Follow up with your provider and discuss your concerns with him or her.
I don’t think you’re going to be able to avoid this appearance if you want to maintain the current size implants you’re using.
My best guess is that simply downsizing your implants will take care of the problem by itself.
It may be necessary to manipulate the pocket slightly, but the implant looks like it’s in fairly good position as it is.
The implants are simply too big.
Best,
Mats Hagstrom MD

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