Will smaller implants alone treat my pseudo synmastia skin tenting problem? Do I need internal sutures? (Photos)

Question

Undermuscle silicone 385 and 450 cc crease incision no kids, 34AA pre-op. Implants are obviously too wide causing the skin tenting/ Symmastia appearance. Will downsizing implants about 100cc treat this alone? Do I need to see a Symmastia revision specialist? Or is there a chance my skin will stretch out and the tenting will go away on its own? What’s the best possible way to go about this ? I am 3 months post op and hate looking in the mirror. Is this a surgical error? Thanks.

Urmen Desai, MD, MPH, FACS · Answer

I would wait another 3 months to see how things change.  After this point if you are still unhappy,  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Gerald Minniti, MD, FACS · Answer

Hello,Along with down sizing at least 100 cc, you will either need repair of the pockets or the creation of a neosubpectoral pocket with obliteration of the old pocket (my preference). If you don't, your new, smaller implants will continue to drift into the medial limits of your pocket, creating symmastia.  If your surgeon isn't an ABPS certified/ASAPS member surgeon who specializes in complex revision breast surgery, you should visit a few who are. Best of luck!

John J. Corey, MD · Answer

I think going to smaller implants and placing some internal sutures will certainly help but… when you look in the mirror see how much of your breast is above the nipple and how little of your breast is below?  I think the majority of your problem is that your implants set way too high on your breast. The far majority of your breast mound is above your nipple with very little below and it should be the exact opposite.  Your implants need to be moved way down! I think opening the pocket underneath the areola and below and out to the side will help get your implants away from the middle and again stitches and smaller implants will help with that as well, but you really can benefit by expansion of the space to the side and at the bottom of your breast. It will give your breast a much more balanced and aesthetic look.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. Sorry to hear you are not happy with the outcome. I think this resulted from poor implant selection and pushing your base width too much. At three months, I would encourage you to wait until 6-12 months before proceeding with any revision surgery. Downsizing the implants is the first part of the repair but if the pocket is still too wide, you will likely also need a pocket revision and possibly reinforcement with mesh. Make sure you discuss your options with your plastic surgeon and if he or she is not board certified by the American Board of Plastic Surgery, then find someone who is. Best of luck!

Farbod Esmailian, MD · Answer

Sorry to hear about your disappointment, but for now I would suggest you hold off on any revision surgery as the capsules may not have completely healed and you may not need any revision surgery come 6 months time.At that time you and your surgeon can accurate assess if there is any need for additional surgery.  Look at how much your breast has changed from your 3 week photo to your 3 month photo.  Things will continue to change until about 6 months time.At that point if you have true symmastia, then treatment would be less wide implants, suturing the pocket closed, +/- ADM/Galaflex.Hope that helps.

Gregory T. Lynam, MD · Answer

If you want smaller implants or more narrow implants then do it now. It is a very emotional process for woman getting implants and despite everything we do to pick the right implants sometimes the patient is unhappy and requires more surgery to make them happy. My best advice is to find pictures in your doctors photo book and show him or her what you like, Good Luck!

Daniel Barrett, MD · Answer

Dear thatgirl2017,you might want to wait three more months to see whether there will be some change in the shape of your breasts. Many women seek improved cleavage. Narrowing the cleavage plane can be done very carefully by a skilled surgeon. Moving the implants too far medially can result in synmastia or unaboob which is very difficult to correct. That being said, the right amount of pocket dissection and implant selection can create excellent cleavage. Based on your information and photos, smaller implants might do the trick. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Tim Sayed, MD, MBA, FACS · Answer

Thanks for the photos and question. I do not think you have true symmastia. You appear to have a narrow cleavage which many patients find desirable. If you do NOT, then there may be a role for revising the capsules slightly near the sternum with capsulorrhaphy repair in order to separate the pockets a bit more. Downsizing may help, including switching to a lower PROFILE implant, but if the diameter of the pocket extends too close to the midline for your liking, downsizing alone is probably not going to completely make you happy. Photos do not substitute for an exam in the office, so I'd suggest going to see a few breast augmentation specialists. Symmastia or tenting are not quite common enough, even if you had them, for there to really be surgeons who "specialize" in symmastia correction, although there are many of us who do a lot of primary AND revision breast augmentation and have seen just about every variant of implant issue under the sun.

Curtis Wong, MD · Answer

are appreciated and you should be discussing this with your surgeon to see what options you have to help you achieve what your goals are.  I don't appreciate a symmastia issue on your photos and many women would kill to get that cleavage but what I do appreciate more is that your upper poles are excessive and you are lacking lower pole fullness and simply lowering your fold would resolve this.  So really think about what you don't like and make sure your surgeon has an answer for each issue or you will still be unhappy when you're done.  And I do not appreciate any obvious errors by your surgeon.

David A. Sieber, MD, FACS · Answer

Thanks for the great question and I"m sorry you're unhappy with your result. It order to fix this permanently you will need to have a new pocket created underneath your muscle and have this pocket support with mesh (either strattice or galaflex). Simply placing smaller implants will not help because the pocket is already there. Smaller implant will still be able to slide towards to middle if you don't further repair the pocket with mesh. I recommend seeing someone who does breast revision to ensure the best results. Best,~Dr. Sieber

Will smaller implants alone treat my pseudo synmastia skin tenting problem? Do I need internal sutures? (Photos)

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