Can Symmastia be fixed with only dissolvable sutures?

Question

I had first my breast aug. 2years ago, and developed symmastia. I want to go bigger (maybe by 150cc), and a doctor I consulted with said it was doable, and he could fix it with only dissolvable sutures. Is this risky?

Gary Lawton, MD, FACS · Answer

The capsule is typically scored or otherwise made fresh, then it is sutured.  The repair is not dependent on the suture, but on the scar that forms on the operated capsule.  Therefore the utility of the suture is to hold the operated capsule in place until a scar is formed.  Dissolvable sutures will do this, with less risk of having a permanent foreign body.

Brian C. Reuben, MD · Answer

Thank you for your question.  There is more than one way to correct symmastia.  Sutures are often used, but the recurrence rate tends to be higher.  If you are considering larger implants, you should consider using additional support material to prevent the heavier implants from pushing on the repair and potentially tearing it.  In many cases, the use of Seri mesh or other materials can be quite useful to reduce the recurrence rate and additional revision surgeries. Best of luck.

David A. Bottger, MD · Answer

Hello and thanks for your question Synmastia, which describes the deformity occurring when breast implants lose the separation at the central chest and essentially move together, can be a difficult condition to successfully correct. Changing the implant pocket can be useful. Also the addition of a dermal graft such as alloderm or comparable material can be employed to reinforce the repairs. At times decisions are modified during the procedure.best of luck

Jonathan J. Staiano, FRCS (Plast) · Answer

Dear fixingsymmastia, Symmastia (or synmastia) is a difficult problem to correct.  It is a risk when large implants are used with a wide base diameter compared to the base diameter of your breast.  I would be concerned about going to bigger implants as this would make it more difficult to correct the problem. On the specific question about the dissolvable sutures, it would not be unreasonable to use dissolvable sutures, although one would tend to use long-lasting dissolvable sutures.  Certain sutures take a long time to dissolve allowing enough time for the tissues to heal and scar together and can be used interchangeably with non-dissolving sutures depending on surgeon preference.

Marc Polecritti, DO · Answer

Yes, symmastia can be repaired with absorbable suture. There are several ways to correct this problem. I, however, prefer to use permanent sutures to limit possible recurrence. I also think using a "mesh" or ADM is helpful to support the repair. I would caution against going larger at the same time of repair though. The larger implant is putting force on the repair, potentially limiting the scar tissue along the middle that we need to prevent symmastia from occurring again.

Steven Wallach, MD · Answer

There are different types of absorbable sutures. Absorbable sutures that take a longer time to dissolve and allow for adequate healing should be fine.

Rick Rosen, MD · Answer

Be careful sometimes what you wish for. Symmastia or a unibreast usually occurs due to over dissection of the pocket. If the implants are under the muscle, then the muscle either tore post operatively or was divided too far during surgery. If your implants are under the muscle, then your muscle needs to be re-attached back down to the split edge. Usually ADM, like SERI, etc are used to reattach those edges. I use permanent sutures for that. without an examination, I can not tell if you can tolerate a larger implant. If you are large now, then stressing the muscle with a larger implant would not be my recommendation. I would make sure you check all bases on this one as you want it to work and be your last surgery for many years.

Steven Schuster, MD, FACS · Answer

It's possible, but not in my hands.  In cases of symmastia I try to create a new pocket (often referred to as a neopocket) to control the implants position.  I reinforce this with a mesh, and the mesh I prefer to use is SERI by Allergen - but thats a personal preference and by no means the only one.  I would be concerned about using only dissolving sutures but I would discuss this with your doctor and possibly seek a second opinion.  Good luck, Dr. Schuster in Boca Raton.

Tom J. Pousti, MD · Answer

I am sorry to hear about the complication you have experienced.   Successful correction of symmastia,  in my opinion  does require some experience;  I would suggest that you do your due diligence when it comes to selecting your surgeon for  this type of revisionary breast surgery.  Ask to see lots of examples of his/her work helping patients in your situation.
 In my practice, having used a variety of “techniques” for correction of symmastia, I find that the most reliable technique involves capsulorrhaphy ( internal suture repair of the breast implant pockets along the cleavage area).  In the past, I preferred the use of permanent suture; more recently, I have had good success with the use of longer-lasting absorbable suture. Sometimes, the use of acellular dermal matrix ( and more recently biosynthetic “mesh") may be helpful also, in some cases where the tissues are very thin. Often, it is necessary to “open” the breast implant pocket laterally (outer breast fold) to allow for positioning of the implant centrally behind the breast mound. This maneuver may also decrease the amount of implant pressure against the medial suture line.  These maneuvers also serve to better position the nipple/areola complexes, centered on the breast mounds. Sometimes, the use of a larger breast implant is possible, once the breast implant pocket adjustments have been made but patients should remember that the first priority is safety and prevention of recurrence of the breast implant malposition problem. You may find the attached link (dedicated to symmastia corrective surgery) helpful to you as you learn more about the options available.
Best wishes.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for your question and as someone with lots of experience in symmastia correction I would suggest going on several consults and become informed about the best options.  It is not about suturedDr Corbin

Can Symmastia be fixed with only dissolvable sutures?

Answers (10)

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