1 year post op, can symmastia be corrected with an implant reduction? (photos)

Question

I went overseas for my breast augmentation which I regret since I got symmastia from it. I also wished I went for a more natural implant size because I look too top heavy. My implant size is 350 cc high profile and it’s been a year since my procedure. Is it possible to swap my breast implants to 200cc without a lift?

Daniel Barrett, MD · Answer

Dear lmaoksure,
I understand your concern. There is a chance that smaller implants will improve symmastia and you might also need pocket tightening. 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

Daniel Butz, MD · Answer

Thank you for your question. Based on your photos it should be very feasible to downsize, fit your pocket and not require a lift. Sometimes a mesh could be helpful in true symmastia situations to close off that medial pocket but a physical exam would be required to determine that. I would expect your skin to retract nicely though and not need a mastopexy or breast lift. 
Hope that helps.

Thomas A. Mustoe, MD, FACS · Answer

In your case yes . It should be very possible to go down in size 150’cc without a breast lift and allow correction of the summations. This shoukd bena straightforward procedure.

Gary M. Horndeski, MD · Answer

You will need smaller implants or explantation altogether.  This would be the best way of correcting your symmastia.  Your breasts are wider than your chest wall and they are touching in the midline.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

I agree that these implants are too large for your frame and need to be smaller. Once taken down, your surgeon can possibly tighten your medial pockets. Mesh might be needed. this can be decided in the OR.

Mats Hagstrom, MD (license on probation) · Answer

Quality breast augmentation is generally based on three variables.
The first is the patient candidacy for the procedure.
The second is the choice of implants in regards to size shape and type.
The third is the surgeons ability to put the implants in the correct anatomic location.
 In your Case all three variables are contributing to your outcome.
Your breast sit wide on your chest wall and to compensate for this your surgeon open the pockets medically. (Towards the midline)
This was a mistake.
The choice of implants also contributed to your outcome and Using excessively large implants made the problem worse.
To improve your outcome the first and most important thing is to use smaller implants.
This will relieve the pressure on the medial pocket by itself.
With small enough implants, you may not need any correction for the implant pocket(correcting synmastia)
It may be necessary to close the pocket to some degree.
Most likely the best decision is made in the operating room but it also depends on how small implants you choose to go with. Using smaller implants will improve the chance of correcting the synmastia. 
Implant selection is an important variable. 
Different plastic surgeons have different ways of guiding patients through the implant selection process.
Some plastic surgeons do this much better than others.
 Some plastic surgeons ask patient to select the implant other plastic surgeons will select the implant based on input from the patient.
I do this is typically in the operating room. 
I do this by first having my patients review lots and lots of before and after pictures.
Once I have a really clear understanding of what the patient is hoping to achieve I bring those pictures with me to the operating room.
I use Temporary “implant sizers” to determine what size implant will give an outcome consistent with the pictures the patient showed me. 
In my opinion, the surgeon is in the best position to select the correct implant because we have far more experience with this kind of work.
That said it’s really important that surgeons listen to the patients and guide patients properly through this process.
Implant envy is real. It’s very common for patients to wish they had a bigger implants six months after the operation. 
For this reason, some plastic surgeons will encourage patients to go with bigger implants.
It’s really important for both doctors and patients to listen to each other. Using excessively large implants will always increase the chance of undesirable side effects(like your situation) complications, and the need for revision surgery(like your situation). 
I generally always steer patient towards using modest implants and especially implants that will fit the natural breast diameter.
I think in your case, your breasts sat very wide on your chest wall, and I think your surgeon was concerned that you would not be happy with the outcome.
When the breast sit wide on the chest wall, this can really limit what the outcome looks like and some patients are unhappy when the breast sit so far apart. 
This look is often amplified with the projection of the implants.
Your surgeon really didn’t do such a bad job even though I think it was over done. Had your surgeon used smaller implants and not placed them so close to the midline you may have been concerned about the outcome as well. It’s very important to understand your own candidacy for the procedure.
When patients are not ideal candidates for breast augmentation it’s really important for the surgeon to explain the limitations, and the impact that augmentation is going to have.
This is especially true when breast sit wide on the chest wall or even more so for patients who have breast divergence.
Correcting your outcome should be fairly straightforward.
To find the right provider to work with I suggest having multiple in person consultations with plastic surgeons in your community.
During each consultation ask providers if they have experiencing correcting this type of outcome and if they can show you before, and after pictures.
If not, ask them to show you the results of breast augmentation with previous patients who had breast that sat wide on the chest wall.
 You wanna see as many before and after pictures of previous patients who had the same body characteristics as your own in the before pictures. 
Highly experienced plastic surgeons should have access to hundreds or preferably thousands of before and after pictures.
Take careful notes about the thoroughness of the consultation.
Correcting your outcome should be fairly straightforward, but I would also be a little cautious of those who think it is easy and the chance of needing a second revision is very low.
Hopefully one revision is all your need but to maximize the chance of having quality outcome from one more procedure requires finding the right surgeon.
Being certified in plastic surgery with years of experience and a handful of positive reviews does not mean somebody has mastered all plastic surgical procedure.
It is your responsibility to find Someone who is truly exceptional at this kind of work.
That generally means having multiple in person consultations.
I generally recommend people have at least four or five consultations before selecting a provider.
I generally recommend people avoid virtual consultations and instead always schedule in person consultations.
I generally always recommend people avoid traveling long distances for elective surgical procedures.
Make a list of plastic surgeons in your community who seem to do a lot of breast surgery.
Consider the plastic surgeons who do most of the breast cancer reconstruction in your area.
Plastic surgeons who are involved with breast cancer reconstruction tend to be overall very good at breast surgery.
Best,
Mats Hagstrom MD

1 year post op, can symmastia be corrected with an implant reduction? (photos)

Answers (6)

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