What Needs to Be Done when Submuscular Saline Implants Are Removed?

32AA to 300 cc saline submuscular-1 year post-op. Need revision surgery(for symmastia)-For now I would just like to remove my implants before going through another possible nightmare.What happens to the released muscle & the pocket created? May want future revision surgery-Could a new pocket be formed submuscular after healing, or would I have to go subgladular (because of the symmastia and/or previous surgery)? Any advice is much appreciated. Thank you!

Doctor Answers 12

What happens after breast implant removal

It 's hard to give you an exact answer without examining you.  However, you'll most likely need to change pockets for the next surgery, and you may need Strattice to fully treat your symmastia.

Baltimore Plastic Surgeon
5.0 out of 5 stars 202 reviews

Breast implant removal for symmastia

The repair of breast implants which have run together in the center of the chest, symmastia, can be an expensive process. The simple solution is to remove the implants and leave them out for at least a year. If you are certain implants are in your future then removal of the breast capsules will increase the odds that the new pocket will not open up into the same one as before.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 43 reviews

Removing Implants after Symmastia

Removing implants with removal of the implant capsule will give your body a chance to heal, and replacing the implants in submuscular position could be done:. 

  • Allow at least 6 months before replacing implants
  • Select implant size(width) carefully to fit your frame
  • Implants that are too big can recreate the problem
  • Ask your surgeon about the use of Acellular Dermal Matrix to add support and prevent recurrence of symmastia.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 41 reviews

Symmastia revision

It is possible to correct symmastia and replace implants in one stage. However, if you and your surgeon elect to remove the implants initially and replace them in a second stage there are several options including changing to a sub glandular pocket and the potential for recurrence of the symmastia may be less.

David J. Levens, MD
Coral Springs Plastic Surgeon
5.0 out of 5 stars 76 reviews

New techniques in correction of symmastia

Symmastia is a difficult problem to fix but with novel acellular dermal matrix, it is made much simpler.  The reason being that your initial operation ended up releasing tissues (either at the time of surgery or afterwards with your tissue relaxation) that almost connect.  Introducing new, stronger tissues can repair/replace what is deficient.  The surgery is technically somewhat complex but extremely effective once the concept is understood.  It is today's gold standard. 

Check out the link below and you can entertain some novel options prior to simply removing what you currently have.

As far as removing them, the capsule needs to be removed and thats it.  The outcome will be a little bit depressing but if you are considering refilling it in the future then it is a solid plan.  Best wishes

Ricardo A. Meade, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 120 reviews

Implant removal

When an implant is removed, often the pocket just closes down. The muscle stays the way it is partially detached from the chest.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast Implant Revision Process When Implant Is Removed

Yes this is a difficult problem, a very difficult problem.   You could have a closure  and implant replacement immediate or you could simply remove the implants, leave them out , and come bace in one year.    I would likely choose the removal only.   You will heal and in all likelyhood return to very near you pre op status by 6 months.     Possibly sooner.   Then if you wish another implant can be tried.   I have seen patients who did this and there was no problem entering the sub muscular space and placing a new implant.   If you wish you ncould go the subglandualr route which is again gaining a little popularity because it is easy, less painful,  can be done under locall anesthesia  and  is less costly.   I am sorry you have had the problems and I wish you smooth sailing in the future.   Dr Commons.

George Commons, MD
Palo Alto Plastic Surgeon
4.5 out of 5 stars 36 reviews

Symmastia correction--just remove implants?

Actually, removal of the implants is not necessary, and IMHO does not really increase your chances for success (or decrease your potential for the surgical correction "not working"). BUT, it does guarantee two operations when one (properly-performed one) may be all that is necessary.

Your symmastia may be due to any of a number of reasons; your surgeon knows if, for example, the pockets were created too close to the midline, too many inferomedial pectoralis fibers were released, or you wore a too-tight bra too soon, causing the pockets to stretch in the middle and perhaps close down on the sides. Each of these should be addressed in any effort to repair the symmastia and make things work out this time. Sometimes this can occur with too-large implants, but 300cc implants are not excessive, so ablation or removal of the medial pocket on both sides, suture closure of the pocket medially on BOTH SIDES, release of the pockets laterally (if necessary), and wearing of a symmastia bra full-time day and night (except for gentle showering) for at least 6 weeks is essential to make this operation work. A regular bra should absolutely NOT be worn (see why above), and you should keep activities low while your new and improved-position pocket heals completely on both sides.

This usually works with one operation, though I have on occasion needed to repeat these steps in a second procedure. Thus, one operation rather than two in most cases, and no time when you are without implants (which is why you had them in the first place)!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews


In treating symmastia you have multiple options.

However you seem not to want replacing the implant now. The most important part for the future is REMOVAL OF THE IMPLANTS AND COMPLETE CAPSULECTOMIES. Suture the symmastia connection. A  special Bra with a small "pillow' in the center to keep pressure where the two breasts connect .

wait 6 months before doing any thing else.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

Submuscular implant removal procedure

Since you have symmastia, I would recommend removal of most of the capsules around the implants and closure of the symmastia.  When implants are in place, symmastia can be very difficult to treat.  While the implants are out, the symmastia will have time to heal.  I do not think you need to do anything to the skin at this time - it will shrink down.  You may be able to go back under the muscle for new saline implant placement in a year.  With your size, you probably need silicone gel implants if placed over the muscle.  Your surgeon can give you proper advice after an examination. 

Randy J. Buckspan, MD
Austin Plastic Surgeon
4.6 out of 5 stars 10 reviews

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.