Fat transfer or new implants? Symmastia hx (Photo)

Question

I can't decide what to do. My implants are old. I've looked at replacing them with new ones or removing them and doing a fat transfer. My Hx: Surgery 1: saline subglandular, symmastia complication. Surgery 2: replaced with silicone subglandular, dissolvable sutures placed to correct symmastia (substandard result) Surgery 3: new surgeon, re-used silicone implants, placed them sub-muscular. I'm worried that tissue in between will look worse if I remove the implants. Can it be fixed?

Randal Haworth, MD, FACS · Answer

When breast implants are placed correctly and are of a large size, they usually do not cause symmastia. However, a larger implant requires a larger pocket, and this may increase the risk of symmastia when the surgery is performed by an inexperienced surgeon. If a surgeon is not adequately trained, they may damage the connective tissues in the center of the patient's chest while trying to accommodate a larger implant. It's important to note that breast implants of any size can result in the "bread loaf" look if they are placed too close together in an attempt to create more cleavage without considering the underlying tissue.

Fortunately, this issue can be fixed with a new technique that I’ve personally used that involves creating a fresh pocket between the existing pocket and the pectoral muscles. This method depends on the resilience of unharmed tissue surrounding the new pocket to avoid a recurrence of symmastia, as opposed to stitching up the impaired tissue in the old pocket.

Fortunately, this issue can be fixed with a  new technique that I’ve personally used that involves creating a fresh pocket between the existing pocket and the pectoral muscles. This method depends on the resilience of unharmed tissue surrounding the new pocket to avoid a recurrence of symmastia, as opposed to stitching up the impaired tissue in the old pocket.

Gianfranco Frojo, MD · Answer

I would highly recommend downsizing implants and performing mastopexies (breast lifts). The problem is that the implants are too large and there is too much breast tissue/skin. The only way to fix this issue is with a breast lift. Regardless, these are all my own opinions based on the photos provided. I would recommend seeing a plastic surgeon who has great training and experience in aesthetic breast surgery.

Chul Hwan Seul, MD, PhD · Answer

If there is no problem with the current implant, there is no need to undergo reoperation to replace the implant with a new one. Even if the implant is removed, symmastia is unlikely to return. If the implants are removed and the fat is transplanted, the breasts will be smaller and sagging more than they are now.

Daniel Barrett, MD · Answer

Dear Imaginative914619,
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

Connie Hiers, MD, FACS · Answer

Your implants are way too large for your frame. If you keep the same size, you will keep the same problems. I recommend going smaller and lifting if needed.

Fat transfer or new implants? Symmastia hx (Photo)

Answers (5)

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