Can I go back under the muscle with new implants after symmastia repair?

I'm getting my symmastia repaired and not getting new implants until 4 months post op. I'm 5'7 and 120 lbs with a minor case of pectus. My implanys are under the muscle now. Am I allowed to go back under the muscle with the new ones or do I have to go subglandular. I don't want to because I know I am skinny and don't want the implants to look so fake. Anyone have this done before?

Doctor Answers 7

Subpectoral post symmatia repair

Yes you can.since you are skinny one option to also consider to make them look more natural would be to take some of your own body fat and transfer/transplant over you breats to create a better soft tissue covering to your breats.This could be done at the same time as your re-aug.


Fort Myers Plastic Surgeon
4.8 out of 5 stars 56 reviews

Symmastia correction

Thank you for your question.  Yes, it is possible to go back under the muscle.  This is often done in a single stage but doing it in two stages works as well.  With a two stage approach, the idea is to let the tissues heal back together and on the second procedure, the pocket is not dissected or created as far medial.  Sometimes adding reinforcement even at the second stage can be beneficial. 

Brian C. Reuben, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 30 reviews

Expert in symmastia repair

I deal with revisional procedures very often as special dedication, among then many cases of surgically induced symmastias, and I can tell you that the two-staged approach is absolutely unjustified, nevertheless is acceptable if the surgeon is not well trained or updated about symmastia repair.

My advice is seeking other opinions; this would be my approach:
-conversion to subfascial plane, since it better allows the re-anchoring of the skin to the ribcage
-multipoint internal capsulorraphy to close the symmastia and re-define the implants' pocket
-anatomical shaped, cohesive gel filled implants, never ever smooth or saline, never, they are prone to poor adherence and dislocations or symmastia
-the maximum adherence implants, this is the macrotextured shell models and, if you want the best nowadays in adherence, go for the polyurethane coated implants which make a velcro effect with your tissues, these latter ones do never fail about symmastia repair

Reparing symmastias is one of the most challenging revisional procedures, many surgeons pretend to know-how, or do it with just a tiny touch up or only resizing implants' width, but that is absolutely insufficient. Seek many experts opinions.

Alejandro Nogueira, MD
Spain Plastic Surgeon
5.0 out of 5 stars 34 reviews

Can I go back under the muscle with new implants after symmastia repair?

I am sorry to hear about the complication of symmastia that you have experienced. In my practice, this repair is usually done in one stage, without the need for breast implant removal first.  This repair is done with a 2 layered suture repair (capsulorraphy), sometimes with the help of acellular dermal matrix or biosynthetic mesh. I generally utilize the same sub muscular pocket, which has many advantages. You may find the attached link, dedicated to symmastia surgery concerns, helpful to you as you learn more. Best wishes.

Symmastia repair best with implants under the muscle

Without knowing more details, it sounds like the attachment of the muscle has been released resulting in the symmastia, and the plan is to reattach the muscle and allow it to heal before new implants are placed. Keeping the implants under the muscle normally helps prevent symmastia. The plan sounds like a good one, but another approach is to do it in one stage using Strattice or SERI to reinforce the muscle attachment. Whether or not this is an option for you depends on your individual circumstances. You will need to make sure that the implants are not too wide in base diameter also.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 47 reviews

Synmastia and back under the muscle - it depends

Synmastia tends to occur more over the muscle, as normally the muscle tends to push the implants further apart. If you were under the muscle before, the synmastia may have occurred because the muscle was lifted off the breast bone too much, or even divided. This could have happened because of surgical technique or because the implants were too large. It is possible to replace them under the muscle, but in order to avoid a recurrence of the synmastia one definitely wants to avoid larger and wider implants that would make the synmastia more likely to recur. 

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 59 reviews

Can I go back under the muscle with new implants after symmastia repair?

The short answer - is yes, you can. Keep in mind that the muscle attaches to the breast bone about 1 inch from the midline. Therefore, give it at least the 4 months for this area to heal before going back in with new implants. Your surgeon must be very careful not to recreate the symmastia.

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.