Mild Symmastia? Does It Look Like Another Revision is Needed? (photo)

If you recently underwent breast augmentation surgery, you are most likely experiencing swelling between the two breasts. This will improve with time and #swelling will subside. Your #healing will continue for 2-3 months following your #breast procedure. There may be some swelling, bruising, malposition, color differences. Sensation will be abnormal and scars will also be changing.During breast implant surgery a pocket is created carefully to maintain certain folds on the sides and bottom of the breast. At times, the space for the breast implant becomes too large on the side of the chest or the tissue stretches and the implants fall too much to the side. This is most easily seen when the patient is lying on her back. On rare occasion, the implants can move towards the patient’s #armpit.Treatment to address this generally requires closing the space.  That procedure is called a #capsulorrhaphy. In this case, the capsule is closed off internally much as we do when we are trying to raise the breast fold. The capsule is then closed with sutures and Acellular Dermis Matrix (#ADM) or other soft tissue substitutes may be used to further support this correction.But, it can be up to one year see your final result. Additionally, your surgeon may require you to move or massage the implants within the breast pockets during the #postoperative period. (#Textured implants do not require breast massage.). This you will be more informed about during your post operative follow-up appointment. In the meantime, you must have patience, but if there are any causes of concern, ask questions of your plastic surgeon or their nursing staff.  

Dear RVAGRL,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

The diameter of the breast implants exceeds the natural diameter of the breasts in the picture. The patient does not have synmastia but does have implants the go beyond the medial border of the breast. It also violate the borders superiorly in the early in laterally. This makes the breast look artificial.

Hello,

I am sorry for your persistent problems with your implants overriding the midline (symmastia). Although this is a complex issue, the way I am interpreting your question is: Do my breasts look too close together?  My answer is yes, both subjectively ( I do not like this look for my patients), and objectively (your right breast implant looks to be past the midline of your sternum, and your right implant is too far out over the sternum).

Capsulorrhaphy is an excellent technique for reshaping the implant pocket which in turn repositions the implant. However, for symmastia issues, this technique does not work as well as another one, which entails making a new submuscular pocket (neo-submuscular pocket) by collapsing and sewing closed the old pocket. Additionally, your repair was bound for failure due to the inappropriately large implants for your chest dimensions, and the use of high profile implants which push the skin envelope away from your sternum more aggressively.

Although others might disagree, I think if you want to get serious about fixing this problem, you will need to let go of your original aesthetic goals of breast augmentation, and allow an expert revision breast surgeon to remove your current implants, definitively repair the pockets, and replace with implants that are both narrower in diameter and lower profile (roughly a 150 cc reduction). Although I am sure you've already spent a lot of money, this is no time to look for the cheapest prices; that will only lead you back to wear you are now.

Best of luck.

Thank you for your question and photos.  It is not clear if the photo on the left is you after your latest revision.  In any event, you have a very narrow distance between the breasts, but not true symmastia.  The basic tenants for repair of this problem is to down size the implants and then use a combination of techniques with suture and/or a biologic tissue (Strattice) to help support the implant medially to prevent it from migrating over.  This is a difficult revision surgery and can be troubled by recurrence of the original problem (implant being too far medially).  Best to have your surgeon evaluate you and the two of you can determine if another revision needs to be done

Best of luck.

 

     It would be difficult to recommend a revision in this situation without an exam, as this is not a routine case.  Kenneth Hughes, MD Los Angeles, CA

Basic principles for symmastia repair include using a smaller diameter implant with less volume and reinforcing the symmastia repair with Strattice material. 

  You do not have symmastia. I would however question the size of your breast implants.  They are larger than the diameter of your chest wall.  You should speak with your plastic surgeon about your concerns.  The solution can be complex.  Good luck.

Whether an additional revision is going to be worth it for you is a personal choice. But if you have another revision the technique can not be the same as the last one if you want it to be more successful. You will likely need to downsize your implants and close off the medial pockets with some type of allogeneic dermis to have a better outcome.

If you like your breasts and the look you have with them, don't obsess over this.  You do not have symmastia where the pockets are essentially one but you do have minimal space between your breasts.  If you absolutely need more space between your breasts, you may have to change implant style and/or size in addition to some internal pocket work and accept the risks of another surgery.  Is that worth it to you?