Hi, I had sub-glandular breast augmentation in 2008,300 cc,a few months later I had a hernia and waves, my surgeon suggested to replace them under the muscle which he did a year ago, since then I find myself with symmastia. I went to another surgeon how suggested internal resolbable sutures and smaller implants 260 CC to correct the problem. I'm wondering if it is a good solution? Should I be worried because he won't use permanent sutures?
Symmastia Repair - Smaller Implants and Resorbable Sutures?
Doctor Answers 6
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.
Repair of symmastia requires that the implant diameter fits the natural base diameter of the breast, so implant replacement is often part of the plan. Permanent sutures will not work better than resorbable ones if the tissue isn't strong enough. The tricky part is that if the muscle has been detached, which is usually the case with symmastia, getting it to re-attach is very unpredictable regardless of suture type. Strattice has been very helpful for this and would be worth looking into.
This problem is unusual and difficult to correct. Narrower implants are needed if you put new ones in however I would suggest that they be removed along with the capsule and let it heal for several months and then consider re-augmentation.
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Repair of Symmastia after Breast Implants.
Techniques vary from surgeon to surgery. I do not feel that choice of suture is as important as the technique used. I agree that in most cases use of Alloderm or Stratus can be used to form a barrier to migration of the implant. That said, symmastia repair is very complex and you should see an experienced and board certified surgeon.
Suture choice is a small issue
The repair of symmastia can be difficult and require revision at times. Your surgeon's choice of suture is a minor point. Look instead into his experience in doing these repairs.
John Di Saia MD
Repait of Synmastia
The preference for repair of synmastia will vary but my personam preference is with the use of a permanent suture and on occasion the addition of an adjunct such as an acellular dermal matrix such as Strattice. In the post-op recovery period it is very helpful to wear some sort of a garment to protect the repair often called a thing bra.
I wish you well.