What are the best options to repair moderate symmastia and bottoming out?

My chest wall was measured at 12.9cm and I decided to go with a 550cc high profile implant that had a diameter of 13.6cm. Issues became apparent about 2 or 3 months post op. To what extent would implant sizes & ADMs affect the outcome of the repair? if I kept my 550cc implants and had capsulorrhaphy using alloderm or strattice what would be a rough estimate of the rate of success?

Doctor Answers 13


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Thank you for your question. You will need a combination of skilled repair to the pocket and smaller implants for long term improvement. I recommend that you seek a board certified Plastic Surgeon who has experience in this area to plan with you.

All the best

Please seen a an experience plastic surgeon for an in-person assessment

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Please seen a an experience plastic surgeon for an in-person assessment.  The issues you are facing can be challenging, but fixable.  However it is impossible to give you any practical advice without properly assessing you.  You want to find a board certified plastic surgeon who is able to show you several before and after pictures of work where he corrected a problem similar to yours.

Options for synmastia and bottoming out.

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Thank you for your question.  Synmastia and even bottoming out can be very challenging problems. 

There are a number of options as I'm sure you know from the responses here.  I will share some of my thinking with you.

First and foremost the weight and the size of the implant can have a dramatic impact on the pocket opening up again no matter which technique you use.  A 550 CC high profile implant is generous.  Think of the implant like a wedge that is used to split firewood.  The weight of the implant, and the force of the muscles contracting acts like a wedge to open up a sutured pocket.

One option, that others may not have discussed here is removing the implant, suturing to close the pocket, and not replacing the implant for couple of months.  Without the force and the weight of the implant the pocket has a much better chance of healing strongly.  While I discussed this option with patients they rarely take me up on it, but I hope it makes sense.

For synmastia, an extra capsular plane can be highly effective but it really depends upon your tissues.  If the tissues are weak than a plane cannot always be dissected well and it may not hold up to the weight of your implant.

Routine capslloraphy can also work well in the right hands but again, a large implant can be the source of failure.

Lastly, Alloderm or Strattice are gaining popularity, but even these may not hold up to the weight of a 550 CC implant particularly if you are slender. 

I wish you success in your endeavors to solve this problem.  Each of the approaches listed is reasonable as long as you understand the possible outcomes. 

Best wishes.

Options to repair moderate symmastia and bottoming out?

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Thank you for your question.  A photograph would be helpful.

As others have stated the use of Strattice or other acellular dermal matrix to buttress a repair of symmastia and bottoming out is currently an excellent option.

The most important thing is the choice of your plastic surgeon.  You need to find a board certified plastic surgeon who has experience in breast implant revision and correcting symmastia and bottoming out.

Symmastia and bottoming out

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pose a formidable problem but without photos, its only speculation.  If your implants are just too large for you, you would have to consider downsizing.  If you went with shaped implants, you could avoid the ADM's and the cost that come with it.  If you want round smooth, capsulorrhaphies and use of ADM will have to be a consideration.  So best to discuss with your surgeon and if you want reassurances, get a second opinion.

Strattice for symmastia (synmastia)

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Agree with the other docs that it is difficult to give an accurate opinion without photos. However, I love strattice for symmastia, stretch and bottoming out issues. I have a lot of strattice experience - more then 150 patients now and the more I use it the more I like it.

Jason Pozner, MD
Boca Raton Plastic Surgeon
4.7 out of 5 stars 45 reviews

Bottoming out and rippling

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Rippling can often be camouflaged by using Strattice in the lower pole. AS for pocket repair, Strattice can help reinforce the repair. 

Breasts augmentation redo

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Dear Kristen,
   A front and side view picture would have been very helpful. Symmastia is a result of disruption of the cleavage area. There are different techniques to restore the integrity of the cleavage area. My prefered technique is to dissect the capsule and create a new pocket medially. I do not find it necessary to use Alloderm.  Bottoming out is a term associated usually with breasts reduction.  In breasts augmentaion patients the more appropriate term is 'double bubble' and this  can occure from, either, over dissection of the crease area or superior capsule contracture that displaces the implants downward . Capsulorrhaphy and superior  capsulotomy will correct that condition. Again. No need for alloderm in my experience. Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center. Most importantly, check the before and after  'redo' breasts augmentation  pictures to make sure that they are numerous, comsistent and attractive. Check also the 'realself' reviews for positive patients experience which provides important information on the surgeons.
                               Best of luck,
                                                  Dr Widder

Repair of symmastia and bottoming out is difficult.

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Hi KristenWave.  That is a lot of questions.  It is harder to answer them without seeing pictures.  That being said, the standard techniqes for repair of bottomed-out implants all include suture repair, repositioning of the implant in the submuscular plane (if it was above the muscle originally), or using an ADM.  It is hard to estimate the rate of "success" without seeing how severe the deformity is not.  The bigger the deformity, the harder it is to correct with satisfactory long-term results.  I think reducing the implant size would be helpful for fixing the bottoming out, and perhaps you are in this situation because your 550 cc implants are too large for your frame.  Symmastia is harder to fix than the bottoming out, certainly it is possible to fix both.  I suggest you discuss your concerns with the plastic surgeon who performed your augment.  If you would rather see someone else, there are many excellent plastic surgeons in Richmond. Good luck!

Lewis Ladocsi, MD, FACS
Richmond Plastic Surgeon


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Thanks for writing,

Symmastia can be a difficult problem to manage. The reason being the thin skin over the sternum is separated and is lifting away. As a result sewing this back down is difficult. New materials (ADM, acellular dermal matrix) have helped correct this issue.

I agree with the other reviewers that you implants are too large and too heavy. There are 454 grams in a pound and as a result you have 1.2 pound of extra weight on each side of your chest. The base width of the implants exceeded the base width of you chest wall and as a result the implant has to go somewhere. In your case it sounds as though it went towards your sternum. The implant may have also gone down your chest wall towards your abdomen.

I would strongly recommend a Board Certified Plastic Surgeon who specializes in breast implant revisions. I am sure he / she will be happy to help you and give you all your options. Good Luck

Stephen M. Davis, MD, FACS
Green Hills Plastic Surgery

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