Symastia Repair: Can It Be Fixed with Perm Sutures with No Alloderm?

I am going back to the PS who did my first surgery. He wants to fix my symmastia by treating it like a "C.C.". he says it will be a 2 hour surgery and he is going to stich all around my lower breast... is this going to help my problem? am I making a Mistake by going back to him? does it sound right what he is doing? he is not useing alloderm is things going to be a problem.

Doctor Answers 11

Symmastia after breast augmentation

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Symmastia can occur after breast augmentation; however, it is a challenging problem to correct.  Most times, it occurs due to over-dissection of the implant pockets.  Depending on how the augmentation was performed initially, symmastia can be corrected by 1) site change (from sub-glandular to sub-muscular plane), 2) placing sutures medially where the pectoralis muscle meets sternum (breast plate), or 3) placement of dermal matrix such as Alloderm.  It would also help by using smaller, narrower implants at the time.  Good luck to you.

Correction of Synmastia

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Synmastia can be  a challenging problem to fix. Synmastia clinically manifests as a "uni-breast" where the cleavage (space between breasts in the area of the chest plate) has been lost. Anatomically, usually it is because the medial aspect of each breast pocket has been over dissected or stretched out.   If the implants were initially placed above the muscle, this can be improved with a site change surgery  and suturing where the new implants are placed under the muscle. The sternal attachments of the pectoralis muscle will prevent the implants from coming too close to each other.   However, it your implants were initially placed under the muscle, then, it is in this scenario that alloderm/strattice can be quite powerful. Alloderm is a regenerative tissue matrix (its essentially a sheet of collagen). There are published techniques where alloderm/strattice can "recreate" and re-establish a barrier for the implants preventing them from migrating medially creating this synmastia effect.  Again, synmastia is a challenging problem. But the use of alloderm has created an option for board certified plastic surgeons to improve this problem.  In addition, it will help to downsize or go with a narrower implant.  Hope this helps.


Symmastia surgery

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Symmastia (medial malposition breast implants) can be corrected with high likelihood of success using medial breasts implant pocket permanent 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.

Symmastia Repair: Plane change and Implant downsize

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Symmastia is a serious complication of breast augmentation surgery and is more common in subglandular breast augmentation with large breast implants. The repair can be difficult and can incorporate sutures (capsulorraphy) or acellular dermal matrix (Alloderm), but more predictable would be a plane change either subpectoral or subglandular, in combination with a breast implant downsize. Please see a board certified plastic surgeon who has experience in the repair of these problems. I hope this helps. Dr. Trussler

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 52 reviews

Synmastia after breast augmenetation

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Symastia is not a very common complication of breast augmentation if certain rules of thumb are followed. Some of my patients request having a cleavage without a bra. Although this is surgically possible, not everybody can have this kind of result. In an attempt to create a cleavage without a bra, some surgeons dissect toward the middle aggressively. This means that, if an implant is placed under the muscle, the muscle’s attachments toward the middle are released, thus increasing the risk of having one of the breast pockets to be too close to the other breast causing what is named as a synmastia, which is a rare breast problem in which the soft tissue connects both breasts across the midline anterior to the sternum.

Repairing synmastia can be done in various ways:

1. Changing the plane where your implant is located. If the implant was placed in a subcutaneous plane switch or to a submuscular plane .
2. Using sutures to close the implant pocket so the implants is not displaced toward the midline.
3. Using alloderm to recreate the pocket.
4. Creating a new plane between the scar that forms around the implant and either in the subcutaneous tissue or the muscle depending where your implant was located.

I like to have control over the pocket when I fix sinmastia. Sutures are not as predictable as you will think. Studies have shown that up to a 20% - 30 % of the times, the sutures become loose. Using alloderm, although it is a good option, it is very expensive.I have found that creating a new pocket by taking advantage of the scar that forms around the implants is a very predictable way of achieving outstanding results. Let’s say that your implant is under the muscle, basically I would dissect between the muscle and the scar around  the implant in essence creating a new pocket for the breast implant.

Good luck

Fixing symmastia

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There are many ways to fix this including implant removal and replacement later, pocket repair, changing the pocket, and ADM like Alloderm or Strattice.  Yours isn't too severe looking so ask the doctor if he has any photos of someone like you to see if you like the result.  If not, seek other opinions.

Symmastia after breast implants can often be repaired without Alloderm.

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Alloderm tends to be overused right now.  Most of the time this problem can be corrected just using your own tissues.  Whether or not you have faith in your surgeon is another issue.  If you have any doubt, go elsewhere.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Breast Synmastia Repair

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There are several options in correcting synmastia.  After consultation and examination with your surgeon the various options can be best discussed. 

Craig Mezrow, MS, MD, FACS
Philadelphia Plastic Surgeon

Synmastia repair after breast augmentation

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Synmastia can be a complicated problem to fix.  Like anything else, the cause of the problem needs to be understood prior to planning a repair.  Simple reasons for synmastia include the use of too wide an implant for your chest width.  More complicated reasons include too much release of your muscle attachments to the chest bone which allows the implants to slide to the middle.  There are multiple options for repair (again depending on what seems to be the cause).  

1) Placing sutures where the muscle was released along the chest bone.  This closes off the "pocket" that the implant sits in essentially forcing it out further laterally.

2) Decreasing the width of the implant to fit your chest size better.

3) Placing the implant in a new location (subglandular versus submuscular).  This change allows the implant to sit in a more lateral position.

4) Using AlloDerm to close off the "pocket" along the chest bone.  This idea is similar to the first one but sometimes patients don't have enough tissue or muscle to suture and AlloDerm gives another substance to use.

If you feel comfortable with your original plastic surgeon, you should continue to be with him/her.  Otherwise, seek another opinion.  Good luck.

Naveen Setty, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 78 reviews

You can have your symmastia repired without Alloderm

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 If your surgeon feel comfortable and confident that he can fix the problem,you should give him the opportunity to fix it. You do not need AlloDerm . Please make sure to not increase the size of your breast implants at the same time.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 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.