Symmastia repair? 6 months post-op large implant removal & lift (Photo)

Thank you for your question. After large implant removal and mastopexy your breast medial cleavage has returned to your normal anatomic shape. I would not recommend further surgery.

Over time, your anatomy has changed due to the effects of the implants on your skin and due to normal aging of the breasts. As surgeons, we can not always predict the final outcome or the way that your skin will adapt after explantation.
In the past, I have had good experience with an inverted "V" plasty where we remove skin and fat from the midline of the breasts following the breast crease. There is always a risk of hypertrophic or keloid scars in this area, however. The result wil be much flatter midline and more division of one breast compared to the other.

Your surgeon did a very nice mastopexy. Your native anatomy shows the breasts run together despite removal of the implants. Some artistic, feathering liposuction is a good option to help define the cleavage. Minimal downtime and risk. I hope this helps.

Hello,
Thank your for your question.
Six months after implant removal and lift, the indentation near your sternum is likely due to stretched skin and volume loss from long-term large implants. While a lift improves breast position, it doesn’t always correct central chest wall laxity. Your surgeon’s mention of dermal matrix or new implants reflects that more advanced reconstruction may be needed to fully address this area. If you wish to stay implant-free, fat grafting could help restore volume and smooth the contour. A second opinion from a board-certified plastic surgeon experienced in explant and fat transfer would be a good next step.

Symmastia may be congenital or related to previous large implants. It can be difficult to correct even with surgery. Options include direct excision of the excess +/- internal sutures +/-ADM (Alloderm) with risks of scarring, keloids and recurrence. Liposuction can help remove the central chest fat then postop "shoelace" or brace for support.

Removing breast implants have consequences. The capsule is usually excised and the pocket is large.
Your breast are large and will sag to the side. To achieve better cleavage., either suture or mesh reconstruction would be indicated. I would wait 1 year before any secondary surgery is performed.

This symmastia was present before your latest surgery, and was not addressed evidently.

No synthetic mesh solution, no need for new implants, you need re-attachment of skin to the sternum bone by means of an "internal bra" at the cleavage, it is technicalled called capsulorrhaphy, multiple "bolts".

Seek the advice of a surgeon with experience in this revision problem.

Thanks for your question! Unfortunately, this is a difficult thing to fix. I would suggest getting another opinion in-person. We work hard to avoid symmastia in the first place because once the cat is out of the bag, it's difficult to put back in. Find a breast specialist in your area. Best of luck!

Thank you for your inquiry! We would love to sit down with you to discuss your options in more detail. Schedule a consultation with a Board-Certified Plastic Surgery to help you reach your goals!

Based off your photo - a comparison photo of you with implants and prior to that would be ideal to understand the anatomy and the evolution of your breasts over the past 20+ years. Unfortunately, having large implants for so long would have led to skin stretch and migration of implants leading to possible symmastia if implants are removed +/- mastopexy (lift). There are techniques to try to repair this but come with higher failure rates - one of them is trying to use dermal matrix to rebuild the lower fold into the midline; there are suture techniques to also attempt to recreate the midline cleavage fold (but none of these are perfect and sometimes a few surgeries might be needed to get it to something you are close to happy with). Discuss with you surgeon more or seek a second opinion in person to see if there are other options.