How to proceed with breast augmentation revision (2/2022) due to symmastia? (Photo)

I think that is a relatively adequate and stable result given the pectus deformity. I would highly consider not having any attempt at revisionary surgery.

Dear Jubilant712483,breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Thank you for your question. The correction of symmastia can be a bit challenging and there are several techniques that can work. In my practice, I do not separate this correction into 2 surgeries and have had good success doing this in 1 stage. I prefer to sew the middle pocket (capsulorrhaphy) and open the lateral pocket (capsulotomy), and will often reinforce the middle repair with a mesh like Galaflex or Tigr to prevent recurrence. For more side-boob, I think your current implants are actually well proportioned for you and would look great if they were pushed outwards a few cm. Be careful going bigger/wider, as this woud just put more stress on the pocket correction. Best of luck with whatever option you choose.

Thank you for your question. You may have symmastia, lateral capsule contracture, and a higher crease on the left side by looking at your photos. In option A, your surgeon wants to suture the inner pocket to correct symmastia by closing the central space between the implants and expanding the lateral pocket to improve lateral fullness, use wider implants to achieve additional lateral fullness, and use a thong bra 24/7 post-op to keep the implants in place. However, wider implants to achieve lateral fullness may be limited by the anatomy of your chest wall and pectus condition. Additionally, if the skin in the cleavage area has already stretched, one procedure might not be enough to achieve a stable outcome. In option B, your surgeon wants an explanation and central pocket repair in the first surgery, allowing the tissues to heal and secure the pocket closure, then re-implantation with potential lateral pocket expansion in a second surgery after healing, allowing optimal placement and stability. So, a staged approach (Option B) is likely more effective for lateral fullness and correct asymmetry.

Thank you for your inquiry! We would love to meet with you and discuss your concerns. Schedule a consultation with a Board-Certified Plastic Surgeon so we can help you reach your goals.

I recommend removing the implants, waiting 3 months and replace the implants sub muscularly. At that time, dissection will stay away from the midline to prevent symmastia. I do not recommend larger implants or wide implants. The implants must lie within the chest wall and should not go off to the sides.

Best Wishes,

Gary Horndeski, M.D.

Dear Jubilant from McLean,
Thanks for posting your pictures and sorry for your suboptimal surgery. From observing your pictures the following is noticed : 1. Symmastia. 2. Lateral capsule contracture or insufficient lateral pocket dissection , which can aggravate the Symmastia and make the nipple point excessively laterally. 3. Left crease higher.
The improvement can be achieved in one surgery with the following maneuvers : 1. Medial capsulorrhaphy (internal bra) . 2 Lateral capsulotomy (scar cutting) to enlarge laterally the pocket up to the anterior axillary line. This will improve the symmastia and the nipple lateralization. 3. Left inferior capsulotomy for crease symmetry. 4. Possibly, supeior and supero-medial capsulotomy if the breasts are tight. That will enlarge the pocket , soften the breasts and create nice upper pole slope.
I hope this helps. Always consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.
All the best,
Dr Widder
widderplasticsurgery.com

The last thing you want is wider or larger implants. That's not the problem anyway, and your PE is only part of the problem; your surgeon overdissected one of the implants to add insult to injury. I am presuming that your pockets are subpectoral, and sewing them closed is a very difficult process, which can fail even if mesh is included (and why useless items like thong bras were invented). The most reliable way of fixing this is to perform a neosubpectoral pocket, which eliminates the need to 'sew skin back down'. Creating a new, smaller pocket that is still under the muscle (by peeling the anterior leaflet of the current pocket off of the underside of the pec major muscle and sewing the anterior leaflet to the posterior leaflet), effectively reconnects the muscle origin to the rib/sternum and the replaced implant actually reinforces the repair. The key is limiting the dissection of the anterior leaflet from the muscle medially. No mesh or thong bra needed, no multiple surgeries, and no fear of failure of the repair.

Synmastia repair in a single stage operation is achievable, especially if overall size goals are compareable to your current size. Over-dissection of the pocket medially leads to the implants being positioned to far medially and loss of the natural cleavage. There is also a fairly prominent asymmetry of your breast IMF with the right side being lower than the left. Although you did not specify, I would venture to guess you have sub-muscular implants given overall tissue coverage. These are tough cases that typically require significant revision of the internal capsule. I believe reconstructing the pocket is best accomplished by created a "neo-submusclar" pocket where the over dissected medial pocket is sewn down to the chest wall and a new pocket is created. Often times I will utilize an ADM or mesh as well to reinforce this newly constructed pocket. At the same time, adjustments to the IMF could be made to further improve symmetry. Finally, a small crescentic breast lift could be done to correct for the asymmetry in nipple position. Correcting the synmastia will improve lateral fullness, however final implant selection is generally best done based on individual measures to ensure implant width is correct for your individual anatomy.
Sean Fisher MDAesthetic Plastic Surgeon

With your anatomy, I would suggest not going larger because of your bone structure will just bring you back to where you are now. Also, I would not go wider because you will still have the same tissue. Your bases are small and wider won't fit. Trying to tighten the medial pockets and perhaps go smaller would be more helpful. Once settled, one areola could be raised to appear more even if you wish.