What is the best technique to fix my symmastia problem? (Photo)

Good morning!I have corrected as many as three synmastia cases in a single day, so I do this a lot. I use the Original Internal Bra, my strong permanent internal suturing technique. I developed this technique about 20 years ago, and currently it is the most common revision I perform, 5-6 times a week, to correct bottoming out, synmastia, and lateral displacement. It works and it lasts.Strattice mesh (an acellular dermal matrix) or other mesh can be used in conjunction with the Original Internal Bra, but not as a replacement for a proper suture technique.In other words, the mesh is not the secret sauce- merely throwing it in there is not a solution, and too many times patients have come to see me from other surgeons for a "failed" repair and I find the mesh in the wrong position, sutured in incorrectly, etc. You need an experienced revision surgeon who can show you hundreds of synmastia cases they have corrected with their own hands. Synmastia is the single most difficult revision in all of breast augmentation, so choose wisely!

The technique I recommend is explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.  Later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

It is helpful to understand the causes of symmastia in order to treat it, and avoid recurrence. Symmastia can develop when the breast implants are too big for the base diameter of the breasts. In order to fit such a large implant, the surgeon has to create a pocket that goes very close to the midline in a sub-glandular placement or goes through the muscle insertion on the lower sternum, in a sub-muscular placement. To treat this problem and avoid recurrence, one needs to use smaller implants. To correct the pocket, there are multiple options. A capsulorrhaphy by the midline and release of the capsule on the sides, closes the pocket by the sternum and pushes the implant away to the sides. This repair is often reinforced by a mesh or an ADM, because the capsule is usually very flimsy and would not hold the sutures. The other option is to create a new pocket. For example, if the implants were placed above the muscle, one can develop a pocket below the muscle. If the implant were placed below the muscle, a new pocket could be created between the capsule and the muscle. These are all ways to control the implant pocket size and location. However, to make the results last, one has to deal with the primary cause. Some patients have tissues that can accept a large implant that is beyond the dimensions of their chest, but most don’t. A detailed history and physical examination, could shed better light on the cause of your problem and the ways to treat it. 

Your implants appear too close, true symmastia has communication across both sides which you do not appear to have.However, treatment is similar. If you augmentation was recent, bra with taping and massage may help.Otherwise, Implant pockets need to be modified. Surgical revision will move the implants more to the sides and close the central area. Changing for smaller implants with or without mesh may be indicated.An exam and consultation with your/a plastic surgeon is recommended to discuss your options and expectations. We are also offering virtual consultations.

Dear Bona32,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

There are special bras that help maintain distance in the midline. Using a bra for an extended period of time that separates the breasts can be effective. I have used thinner implants, not as wide as your existing implants and special capsulorraphy techniques that use sutures to shore up the medial component of the implant pocket. Gala flex or other mesh products maybe helpful... See a board certified ASAPS plastic surgeon in consultation. Good luck...

Your before pictures and implant information would be helpful. You have mild symmastia and will need to do Capsulorrhaphy. This involves suturing the pocket over the middle and releasing the pocket so the implant can shift more to lateral position. 

Dear Bona,You appear to have your implants too close to the midline.  Whether or not it is a true symmastia (when the implants tough) is not a concern...it needs to be revised.All of the approaches to fix this situation are valid.  Many patients require only midline plication with lateral pocket opening to allow the implant to go laterally which also fixes some of the lateral pointing nipple/areola that you now have.  Some require a smaller implant or using an ADC (acellular dermal matrix like Strattice , alloderm or galaflex etc to bolster the midline repair.  Best of luck with your search and repair.Dr T

Dear Bona32,You do not have true synmastia.  Your breast implants are very close to the midline.  Internal mesh placement, internal capsule tightening, smaller breast implants and lateral release of the breast implant pockets are all possible options for repositioning.  Have a discussion with your plastic surgeon to see which options are best for you.  Good luck!

Sorry for your problem and symmastia can be reliably repaired with creation of a neopocket more lateral then the present one with or without the use of a ADM like galaflex and ideally smaller implants.Dr Corbin