Subglandular symmastia! Will there still be tenting between my breasts even if it is fully fixed? (Photo)

Question

3 years ago I developed symmastia with 300cc overs. 1 year later I explanted, with my breast bouncing back to pre-op (although skin in between cleavage does feel slightly looser now). I want to re-implant again but with a small implant (175cc) with a good gap in cleavage going under the muscle. I would like to know whether there will still be tenting in between my breasts even if my symmastia is fully fixed? In that case I would rather stay implant free.

Alejandro Nogueira, MD · Answer

I'd like to shed some light to your (abslutely justified and understandable) concerns; you have received very poor work before, worst remedial surgery afterwards and an awful medical advice for your future surgery, additionally you have developed lay theories and this is regularly very unlikely to be a solid ground to patients; in other words, the lack of good medical advice can't eve be replaced by patient's own theories after "researching on the Internet" or self-advice based on "logic" without the necessary tissue mannipulation experience; I am not blaming you, you may well feel a bit hopeless and stranded with your breast problem, I only try to set a reliable scenario for your case based on my vast experience in revisional procedures (majority of my revisional breast patients have the same attitude and have developed their own self-help).Let's begin with teh difference between symmastia and tenting; they both may look the same aesthetically but they are NOT the same:-symmastia: this can be congenital or iatrogenic; congenital symmastia is when the woman has a fusion of breast tissue across the sternum bone bridging both breasts in a higher or lesser degree; the treatment of congenital symmastia is complex and tedious, consists in lipo-glandulectomy in a custom-tailored cleavage all under the pre-sternum skin and a multipoing mastorrhapy or mammorrhaphy to anchor the newly build intermammary space and cleavage skin to the deep tissues; iatrogenic symmastia happens when the surgeon over-dissects the breast implants pockets towards the midline leading to a close-to-touch each other scenario or full communication or, more commonly, when the surgeon makes a not that aggressive dissection at the midline but inserts a massively oversized implants with too wide prosthetic base width with over the next postop weeks or months dissects and expants the midline to the poing or symmastia, NOTHING TO DO WITH CC OR GR of the implants... and this is your MAIN CONCEPTUAL ERROR; it is a matter of dimensions (with the same cc's you can find in the marked DOZENS of different implants with different sizes, different breast increase effects and obviously differend base widths; also I'll have you know symmastia has NOTHING TO DO WITH THE PLANE of location, you'll develop it at any plane if things go wrong-tenting: here the implants do not touch each other and do neither staty tightly close to each other, however the pre-sternum skin is lifted up creating a "tent" or web effect between the breasts, thus deleting partially or subtotally the cleavage; this tenting issue can be a standalone problem or associated to a certain grade of symmastia; also a patient prone to tenting may later on induce symmastia easily if the implants are too wide; tenting is not directly attributable to surgical actions during the procedure, it is a wrong preop judgement of the case, however I must tell you it is extremely difficult to predict which patients have tenting risk and which not, takes decades of experience and requires a very wise clinical eye chasing the prone-to patients, so I'd not say it is always an avoidable complication, let's say 70% of tenting cases are avoidable with good preop judgement to an average skills/experience surgeon and the other 30% can be foreseen by top-level surgeons only, sometimes complications are unavoidable, let's try to put things into context and not be manichean; which are the factors making patients prone to tenting? easy and only one: poor adhesion of the pre-sternum and cleavage skin / ligaments to the bone and underlying tissues; when this is detected the surgical approach is letting the patient know her likeliness to tenting and offer one of the following 3 options: 1. sacrifice implants base but preserving the projection requested (actual breast increase), thus losing cleavage fullness and accepting a larger gap between breasts; 2. sacrifice implants projection but preserving the base, thus losing breast increase but keeping good intermammary fullness; 3. (only if the surgon has skills for this complex one) keeping the planned implants base and projection thanks to applying a prophylactic multipoing mastorrhaphy / capsulorrhaphy at the cleavate to treat preventively the tenting, with the downside of a substantial price increase due the additional surgical time-mixed situation: like yours preoperatively; you were a victim of poorly chosen implants, they had a massively too large base width (the cc's have NO RELEVANCE here or elsewhere in breast augmentation considerations); you were a case for a large or small augmentation (your decision, your privilege, you rule) but never for such broad implants; additionally you were tenting-prone and this was unadverted by your surgeon; the wrong choice of implants is attributable to your surgeon (as well as poor pocket planning and grotesque eccentricity of nipples, the pocket had to be more lateral), the tenting detection could or could not have been previously detected, unclear, but existedWith that said... the decision of removing the implants was a WRONG decision, condemned you to a long period without your dreams; you should have sought the services of a surgeon with experience and passion for revisional mammoplasties and symmastia / tenting repair with capsulorrhaphies and good implant sizing choice skills. Actually, as you well mention, the separation at your intermammary skin is still there, I mean, the skin from the pre-sternum area and inner cleavage has NO attachment to the bone or muscle, therefore may the next surgeon simply insert implants (even well sized, with correct base width and properly located) you will develop again tenting since the skin freely floates on the sternum without any ligament; you necessarily need the mastorrhaphy to reanchor the skin and create a tightly adherent cleavage foolproof against any kind of implant inserted.So answering you, yes, your tenting and symmastia will return becase, to the contrary of your thoughts, the symmastia IS NOT FIXED, just is non-apparent, but is there like a hidden wolf awaiting the next pair of implants to be inserted.And finally, there is no reason to stay implant free, you only need a good surgeon with vast experience and solid background in revisional procedures, who knows how to deal with the wolves.If you wish better grounded opinion please do post or send privately well lit, focused and standard images: frontal, both lateral and both oblique views.
Feel free to request any additional information from me.

Tom J. Pousti, MD · Answer

I am sorry to hear about the complications you experienced.  Unfortunately, despite successful correction of symmastia, some degree of skin tenting may remain ( especially when patients are wearing tight fitting bras or clothing). I have found that the use of acellular dermal matrix to support the capsulorraphy repair during symmastia surgery does seem to help with skin tenting concerns. You may find the attached link/video helpful to you as you learn more. Best wishes with your decision-making and for an outcome that you will be pleased with long-term.

Gregory T. Lynam, MD · Answer

A lower profile silicone implant under the muscle should do the trick.  I would not go above the muscle again. See an experienced board certified plastic surgeon in you area for consultation,Good Luck

Daniel Del Vecchio, MD · Answer

your best bet is smaller implant-175 under musclecover with fat to give natural look hope this helps!

Subglandular symmastia! Will there still be tenting between my breasts even if it is fully fixed? (Photo)

Answers (4)

Answer: Synmastia- reducing risk

Answer: Synmastia- reducing risk

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Everything you need to know about Breast Implant Revision

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Subglandular symmastia! Will there still be tenting between my breasts even if it is fully fixed? (Photo)

Answers (4)

Answer: Synmastia- reducing risk

Answer: Synmastia- reducing risk

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Recommended reading

Everything you need to know about Breast Implant Revision

Our mission is to create a world where every investment in modern beauty is Worth It.