Am I developing Symmastia? My skin is lifted off the sternum.

Question

I’m 4 months PO 5’3 116lbs. I have 400cc L and 400cc R. (Under the muscle )I think I’m developing Symmastia. I’ve contact my PS and he said it was swelling and I just need another opinion.

Lawrence Iteld, MD · Answer

A small amount of skin evelation is usually not a problem as long as the implant pockets are still distinct and the implants are “staying on their own side.” If the midline is violated a revision procedure may be recommended.I would recommend seeing another Board-Certified surgeon for a second opinion.

Mathew A. Plant, MD, FRCSC · Answer

It certainly does appear as though you are developing symmastia. It's less common with under the muscle placement, but it's even less common to have your swelling start to INCREASE at 4 months. I would suggest having an in-person consultation by a local breast implant revision expert to be properly assessed for a second opinion. Hope that helps!

Daniel Barrett, MD · Answer

Dear Paula1012,symmastia is a rare breast condition that occurs when soft web-like breast tissue pulls breast implants towards each other, until the breasts meet uncomfortably at the center of the chest near the sternum (the body’s midline point). Given this abnormal union, symmastia is known by many other names, including breadloafing, kissing breast implants, and the uniboob.Unfortunately, this condition causes the surrounding skin and pectoral muscles to literally lift off the breast bone as the implants are pulled together. This consequently causes pain and discomfort, as well as obvious distortion of the breasts, which can only be disguised with clothing that does not show cleavage.You should consult with a board certified plastic surgeon for proper assessment. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Aditya Sood, MD, MBA, FACS · Answer

Thank you for your question! It does appear as though the skin directly above your sternum is stretched but you do not have synmastia to the full extent, at this point. In a true under the muscle augmentation, it is impossible to get synmastia because the muscle is never released fully from its attachment to the sternum. Some surgeons will to varying degrees release the muscle from inferior to superior along its medial attachment of the sternum. So although it is not common with a submuscular augmentation, it is certainly possible. In your case, it seems as you have fairly large implants and good skin quality. Sometimes if you give the the skin a chance to accommodate the stretch and give the implants a chance to descend with gravity the result will improve markedly over time. Since you are 4 months out, I wouldn't expect much "swelling" to be causing this deformity. I would suggest giving it a little more time for the skin accommodation and descent of the implant, but if the stretching persists you may consider seeing a surgeon to either fix the synmastia (if that is the culprit based on physical exam), vs. downsize your implants slightly. Best of luck to you!

Curtis Wong, MD · Answer

but did you start with that (as some people do)?  And if not, how extensive of a medial pocket release was done (only your surgeons knows)?  And if the medial pocket release was not aggressive, you will not have symmastia and this will improve with time.  If aggressive, then there is a chance this is developing.  You need to trust your surgeon to be truthful with you and to have your interests first and foremost as you are walking advertising and he/she should want the absolute best outcome for you.  So follow his/her instructions and if you do develop clear symmastia, your surgeon should be very motivated to repair this under the known revision policy (there is one right?) to make it right.

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast surgery.  Although symmastia is not present,  I do understand your concerns about the breast implants being quite close to one another in the midline.  if breast implant positioning is of concern, you will benefit from bilateral medial breast capsulorraphy (internal suture “repair”) as well as lateral capsulotomy to improve your situation.  
In my practice, having used a variety of “techniques” for correction of medial implant displacement and symmastia, I find that the most reliable technique involves a 2 layer capsulorrhaphy (internal suture repair of the breast implant pockets along the cleavage area). Often, the use of acellular dermal matrix is helpful also. I have also been pleased with the (at least partial) correction of skin tenting that can be achieved with the use of the acellular dermal matrix.
As mentioned above, it is usually necessary to “open” (reverse capsulotomy) 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. 
It may also be necessary to change breast implant profile or volume to help prevent chances of recurrence of breast implant malposition.
This procedure will serve to improve the position of your breast implants on your chest wall, better center the nipple/areola complexes on each breast mound.
Careful selection of plastic surgeon will be one of the keys to success: make sure that he/she is a board-certified plastic surgeon who can demonstrate lots of experience helping patients with this type of revisionary breast surgery. I also find that careful attention to postoperative activity restrictions is key to success with this type of surgery and other types of implant malposition revisionary breast surgery.
I hope this helps.

Chad Robbins, MD · Answer

Hello and thank you for your question and photo's.   At 4 months your swelling is minimal to none.  Patient's who are thin with narrow torso's are at higher risk for tenting at the sternum, especially with larger implant's.  You may want to see another Plastic Surgeon (Board Certified) , or return to your's and may need to have an implant exchange to smaller implants while closing the medial pockets and maybe extending the lateral pockets .

William C. Rigano, MD (retired) · Answer

At 4 months,swelling is minimal in my patients. Certainly the sub muscular implants seem close to the sternum and wide at 4 months. Gentle massage to the outside may help allow the implant to shift away from the midline,but it is a little late to try at 4 months. You may want a second opinion from an experienced PS

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
From your limited photos, you appear to be exhibiting a skin bridge between the breasts, suggesting symmastia. The photos exclude the lateral aspects of the breasts. Are they constricted? If the implants are of correct diameter, they are malpositioned and require lateral capsulotomy. If the implants are too wide, you require narrower implants. You may also require tightening of the medial aspects of both pockets.
Discuss this again with your plastic surgeon. You may wish to seek a second opinion if not satisfied.
Best wishes...

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