Do I have congenital symmastia and did my over the muscle implant placement make it worse? (photos)

Question

I need to know if I have congenital Symmasia and if so the fact I had implants above the muscle did this make it worse ? I have added pictures from before surgery, after a reconstruction and before implants and then after implants my only aim was to fill the upper pole after an original breast reduction surgery in 2007. I have lipoedema, connective tissue disorder and massive weight loss and loose skin, all of which surgeon knew. At no point before surgery was I informed I had symmastia

Daniel Barrett, MD · Answer

Dear Mitopher,
based on your photos, it looks like you didn't have congenital symmastia. I understand your concern. 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

Stefan Mark Szczerba, MD · Answer

From what I can appreciate from your photos, your breasts simply do not have a large intermammary distance but there is no disconnection of the skin from the sternum that symmastia patients have.  Placing an implant on top of the muscle likely just added volume to the breast and with that added volume your intermammary distance appears even more decreased.  The skin over your sternum does not look disconnected from the underlying sternum though.  Best Wishes!!

Camille Cash, MD · Answer

From the photos it does not appear that you have symmastia.  While your concern can be appreciated it does not appear that the skin is lifted away from your sternum.

Connie Hiers, MD, FACS · Answer

No, you do not have symmastia either before of after surgery, but you do have some loose skin that stretches in that area.

Mats Hagstrom, MD (license on probation) · Answer

I don’t see significant symmastia in your pictures.
I think your biggest problem is related to the excessive skin redundancy.
Removing that much breast skin is inherently difficult and led to the outcomes you have.
I think most plastic surgeons would probably favor, subpectoral augmentation, but there’s nothing inherently wrong with placing the implants above the muscle.
 Both techniques have their advantages and disadvantages.
Using excessively large implants is going to increase the chance of complications and need for revision surgery.
I think the size of your skin envelope is contributing and inherently limited the aesthetic potential outcome.
Compared to where you started I think your outcome is actually fairly typical or average.
Best,
Mats Hagstrom, MD

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