Skin Lifted off Sternum Between Breasts? (photo)

Wraps and straps can reposition implants in the first few weeks after surgery but are not of much help this far out from surgery. Even if a strap could make the midline skin stick back down the result would not be optimal.

Your posted photos show nipples in different positions relative to the midline, symmastia, a larger left than right breast and a lower left inframammary fold. I suspect that you had some asymmetry before surgery that was not addressed and/or recognized. Sometimes hard to see asymmetries with small breasts become very visible after breast augmentation. Unfortunately you will have to start from scratch and will now need more adjunctive procedures than you otherwise would have needed. You may also need to place 2 different sized breast implants to get better symmetry and be amenable to using acellular dermal matrix to fix the symmastia.

You definitely need revision surgery but you should see a few surgeons before picking a revision surgeon and make sure your next surgeon sees the operative report, exam and before photos of the first surgeon before proceeding.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

At four months after the surgery it is quite unlikely that any non-operative maneuvers will correct this problem, and in that regard I agree with you that a revision will be needed and can be done at any time. 

The implants are currently positioned too medially, and seem to be touching each other (symmastia). 

The solution will be surgical--


consider smaller implants to minimize chance of recurrence

capsullorhaphy, or suture repair to close off the inner part of the pockets. Sometimes this can be done with sutures, sometimes it requires adding Strattice, an acellular dermal mattrix which is a biological tissue replacement. 

release the pockets laterally. This will allow the implant to move outward, and the nipples and areolas will be better centered on the breasts.


Thanks for your question and for the photos. All the best. 

Your concerns about the results post augmentation is valid and can be corrected.The technique to correct the symmastia depends on the degree of the migration and implant size. I would not go with smaller implant and just revise the implant pocket. Your surgeon should be able to help you and if not,search for board certified plastic surgeon.

 

I'm sorry to hear/see about the concerns you have after breast augmentation surgery. Based on the photographs, it is clear that you do have issues related to breast implant displacement/malposition.  Both breast implants seem to be medially malpositioned and one seems to be significantly lower than the other.

 In my opinion, revision breast surgery will become “necessary” to correct the breast implant displacement issues. This operation will likely involve capsulorrhaphy techniques to close off the breast implant capsules in the areas involved. Doing so will help prevent the breast implants from moving too far towards the middle and inferiorly. The position of the nipple/areola complexes  on the breast mounds will be improved  as well.

 Unfortunately, even after  capsulorraphy surgery, skin “tenting” ( skin lifting over the sternum) issues may persist.

 You may find the attached link helpful to you as you learn more about revisionary breast surgery.

 Best wishes.

Dear dlb,

I agree with the surgeon below.  You have symmastia as well as asymmetrical breast pockets with your left implant lower than your right.  I would suggest more narrow implants with repair of the sternal area as well as the area below the implant.  Also, I would recommend considering using a dermal matrix to re-inforce the repaired areas to help prevent relapse.  Discuss your concerns with your plastic surgeon.  He was attempting to give you as much cleavage as possible.

Best Wishes,

Pablo Prichard, MD

I agree that what you have is called symmastia.  Correction will not be simple but I think you do have some options.  In general, you would need smaller implants, a new pocket for the implants, the addition of ADM (acellular dermal matrix, such as Alloderm or Strattice) for the medial edges of the pocket and, most likely, the lower limits to raise the inferior limits of the pockets, as well as suturing the skin of the sternum back down.  With all of those manoevers I think you can get an improved appearance, but it may, in fact, take all of that.

I hope that this helps and good luck,

Dr. E

In reviewing your case I can see the cause for your concern. At 4 months post op you have what is called symmastia. In my opinion a strap at this time frame from surgery will not correct the positioning of the implants. In my opinion, a surgical revision will be necessary. You will need to have the implants exchanged for more narrow implants and the breast pockets sutured medially and released laterally. Speak with your PS and discuss all the options for correction of this situation.

Best of Luck.