I am going for a consultation for symmastia revision. I would describe the symmastia as moderate. I do not want an overly large gap between my breasts post-operatively, but I do not want to end up needing a second revision surgery for symmastia. What is the chance of recurrence and what should I discuss with my doctor? My implants are smooth round moderate plus, 510 cc under the muscle.
What is the Chance of Recurrence of Symmastia?
Doctor Answers 9
At 510 cc, your implants are large. They project far into the armpit and centrally, to the point that they meet in the middle, synmastia.
Repair of the pockets is a difficult procedure, and not perfect. The repair can fail, especially if large implants are still present.
Sometimes the best procedure is to remove the implants, downsize or remove them altogether to allow the natural pocket to build strength again before replacing with smaller implants.
Placing the implants above the muscle is also a potential solution which may involve a relatively new pocket, but the patient will have the disadvantages (rippling, palpability, visibility, reduction in blood supply to the nipple) inherent with that approach.
These are technically complex procedures and a great deal of experience with revision breast surgery is a must.
Thanks for the question
Symmastia can be a difficult problem to correct. The natural tissue that separates the two breasts has been disrupted. Techniques to correct this include using suture techniques to re-establish the separation.
The problem is suture techniques can fail over time. The chance of failure of the repair depends on many factors including severity of symmastia, your tissue quality, etc.
I would ask your surgeon about the technique he or she plans to use to correct your problem.
I hope this helps.
Correction of this problem may involve using different implants such as textured, a smaller size, or a smaller base and placing the implants in a new pocket. On occasion, this may require surgery in more than one stage to allow the tissues to heal and then place the implants. If the implants have been placed above the muscle, converting them under the muscle frequently will help and, again, the use of a dermal substitute may be required for additional support if the tissues are thin. The techniques of capsulorrhaphy and neopectoral pockets may apply here as well.
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Symmastia (medial malposition breast implants) can be corrected with high likelihood of success (about 90% success rate) is using medial breasts implant pocket sutures (medial capsulorrhaphy), lateral capsulotomy (if necessary), and/or the use of allograft. I do not believe that a staged procedure, involving removal of implants for period of time, is necessary.
There is a learning curve with this operation and I recommend that you seek consultation with a board-certified plastic surgeon with significant experience treating this problem. You may find the link attached below helpful.
There are a few critical things that you need to do to achieve a good, long lasting repair. First, you need to change the pocket for the implant if possible. If this is not possible, then you need to reinforce the medial areas with both capsule work and possibly some Alloderm/strattice. The other thing that needs to be done is to change the implant to a device that is not as wide as your current implant. This may be downsizing the implant, or may be changing to a different profile. If you do these maneuvers, then the chance of success is high. However, you really have to be cautious for at least three months and allow the areas to heal and seal off before stressing them.
Revision of breast implants should give you good result.
I do not agree with my colleagues. With good technique, permanent correction of symmastia after breast implants can be achieved. The key is to make new implant pockets. I do agree with my colleagues in recommending smaller implants.
Symmastia repair does not always work. It would be a good idea to go with a smaller implant. The repair usually entails some sore of capsule tightening procedure for mild cases.
Symmastia is a tough problem
Symmastia is a very difficult problem to treat. Your implants (510cc) are also very large implants. The best treatment is to change the position of the implants to subglandular AND to make the implants smaller. It may be very wise to remove the implants for several months first before doing this procedure. I agree with everyone that this is very difficult to treat and you should go to a plastic surgeon with quite a bit of experience in revision breast surgery. Good luck.
Synmastia is easier to avoid than treat
The natural barrier over the sternum has been disrupted in your case and is hard to recreate. Many techniques have been tried and suture techniques with immediate re-insertion of an implant are probably the least successful. Generally you need to downsize the implants, often create an entirely new pocket (in your case subglandular), and sometimes take the implants out and wait several months for healing before going back in. It is a tough challenge. Make sure your surgeon is very experienced in breast surgery.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.