Is Breast Revision for Symmastia Difficult?

right breast is a lot higher, has a band up and down between the center of the breast and nipple, Hard feeling. Line across the center of chest connected to other breast, lifts up the center of my chest when the muscles flex. very tight feeling. Any twitch, Implants move muscle flexion. Can slide chest side to side with center moving. right breast cross over the center of my chest. Left breast has some of same issues. center lifts off when bend over or where push up bra. Looking for Michigan Dr

Doctor Answers 10

Symmastia surgery

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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 experience treating this problem. You may find the link attached below helpful.

Best wishes.

Capsular Contracture and Symmastia Repair

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Based on your description and photograph you have capsular contracture on the right breast and mild symmastia. The treatment of these two are completely different. You will need a capsulectomy on the right side and a new implant. For the symmastia, you will need the communication between the two pockets to be closed internally with sutures.

These two procedures have a higher rate of needing further revision surgery. One reason is that in order to keep the breasts soft and decrease further encapsulation, breast massage will need to be performed. However, breast massage may also disrupt the sutures used to fix the symmastia. A few ways to minimize this are to use similar or smaller size implants, wear a special type of bra called a breast separator for 4-6 wks after surgery, and as another doctor mentioned, stage the procedure. 

Hope that helps and good luck!

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 51 reviews

Treatment of symmastia and capsular contracture

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The condition you describe and what can be seen in the photo is a connection between the 2 breast implant pockets and a capsular contracture. Their treatment is more difficult than either one alone or placement of first time breast implants. The scar capsule needs to be removed and then the connection between the 2 pockets closed off with sutures. Sometimes you have to place Alloderm or other skin matrix in order to have strong tissue that will hold the sutures. Certainly replacing the implants with smaller implants (in base diameter and projection) will help the situation. It also sounds like there is scarring connected to the chest muscles and/or the implants are under the muscles. I do not know how close you are to Detroit but you can try Dr. Kenneth Shaheen or Dr. Michael Busuito both in the Detroit area.

Aaron Stone, MD
Los Angeles Plastic Surgeon

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Symmastia is a difficult problem but can be corrected

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I have treated less than 10 patients over 28 years with symmastia and have performed over 3000 breast operations. As you can see from these numbers it is not a common problem, which is fortunate. Since I'm being referred more patients for revision of cosmetic breast surgery recently, I have seen five of those 10 patients in the last five years. I've been using dermal matrix grafts such as Strattice and Biodesign with very good results. Basically, the graft is placed as a barrier between the implant and the lateral aspect of the breast bone, and the breast bone itself reattached to the overlying tissue using fibrin gel and platelet rich plasma.

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.3 out of 5 stars 27 reviews

Michigan Plastic Surgeon

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Hello and thank you for the question. 

Reviewing your photograph and history, you need a board certified plastic surgeon with experience in breast revision surgery. I recommend Lawrence Tong in Birmingham, MI. Tel. 800.401.1212.

Best of luck,

Glenn Vallecillos, M.D., F.A.C.S.

Glenn Vallecillos, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 30 reviews

Contracture and symmastia a difficult revision

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From what you describe, there is an animation deformity, symmastia, and a capsular contracture. This is the type of revision that requires special expertise. Talk to Dr. Brad Bengston in the Grand Rapids area.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Treatment for synmastia is difficult and best done in 2 stages.

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My advice to you is to remove the implants and the capsules without immediate replacement.  After 3 months, the tissues will be well healed and a straight forward breast augmentation can be performed without the need for direct repair of the synmastia (it will have healed over the 3 month rest). 

Coomplicated breast implant revision

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This is a difficult problem and is likely associated with a higher rate of revision. Consider Dr. Dennis Hammon.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Symmastia and capsular contracture

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A capsular contracture can be treated by removing the capsule and possible placing the implant in a different pocket plane.  The symmastia can be corrected at the same time.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Symmastia repair

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From what you describe and from your photos, it sounds like 2 separate issues. It appears as though you have a capsular contracture of the right breast. Firmness and elevation are two common signs of contracture. Symmastia is the abnormal communication between the breasts which can be static (seen all the time) or dynamic (only seen with breast motion). Both repairs are quite challenging, however are somewhat similar. The goal of capsular contracture repair is to remove the offending scar tissue (capsule) and to place the implant in a new "pocket." This may changing the site to above or below the muscle depending on the previous site. Symmastia repair is similar. Symmastia is often caused by:

  1. Implants which are excessively wide for the patient's chest
  2. Overdissection of the medial pocket
  3. Repeated breast augmentation over time

To correct symmastia, suturing the medial pocket closed combined with a site change of the implant can work. There is even a technique, known as the neo-subpectoral pocket which allows for keeping implant placement under the muscle, but essentially closing off the symmastia communication. I've included a link to an article below. If you need a plastic surgeon in Michigan, please contact me and I'll be happy to provide you a recommendation.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 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.