I had BA in the end of 2010. The implants are 300 & 325, round smooth gel silicon made by Mentor. IMO, my issues are: Symmastia, Capsular Contracture (After 5-7 days of the surgery, I guess the fever, redness, hematoma I faced caused it), Implant Malposition. I really appreciate your advice with a very detailed techniques and procedure for revision, which I will use to discuss with surgeons. I'm in developed country. Therefore, your opinions is extremely valuable. Please please help!!!! Thanks.
Symmastia, Capsular Contracture, Implant Malposition. What Are My Options? (photo)
Doctor Answers 2
Correction of Symmastia?
Thank you for the question and pictures.
Although it is not possible to provide you with precise advice without direct examination some general words of advice regarding a medial breast implant malposition may be helpful to you.
Medial displacement of breast implants is known as symmastia. This is commonly referred to as "breadloafing" or "uni-boob".
This results from the loss of tissue support along the sternal area, allowing breast implants to move excessively towards the woman’s midline. If the pectoralis muscle that is connected to the sternum and goes across the implant is cut during surgery, then the implant can move toward the middle of the chest.
Symmastia may result from overly aggressive attempts to alter chest wall anatomy trying to increase cleavage in patients. This outcome is made worse by use of larger implants in thin patients, and is a problem for implants over or under the muscle, though submuscular implant placement allows the muscle to provide some softening of the transition to the cleavage area from the augmented breast mound.
The degree of medial displacement varies from patient to patient and the reconstructive technique therefore, also varies. Usually, the medial displacement of the breast implants causes the nipple-areola complex to appear off-center on the patient’s breast mound. Often, there are other problems associated with the symmastia including “bottoming out” (inferior displacement of the breast implants), rippling / palpability of breast implants and breast asymmetry.
Correction of symmastia involves careful planning and intra-operative reinforcement of the medial fold of the breasts. Reconstruction usually involves removal of the breast implants and internal suture reinforcement of the involved area. The use of dyes and needles through the skin surface assists the exact placement of permanent sutures. Usually the breast implant capsule that is redundant is removed to allow for two raw surfaces to heal together, presumably lowering the rate of recurrence of the symmastia.
Often, it is necessary to “open” the breast implant pocket laterally (outer breast fold) to allow for positioning of the implant centrally behind the breast mound. This maneuver may also decrease the amount of implant pressure against the medial suture line. Use of a smaller breast implant, if possible, may serve the same purpose.
For correction of symmastia, the procedure can take from 2-3 hours depending on how much work is involved.
• An incision is made (usually under the areola) to expose the underlying tissue, muscle, and implant.
• The tissue that surrounds the implant is removed in the area of the planned repair.
• Tissue is sutured together to hold implant in place (with permanent sutures).
• The incision is then sutured close.
Intra-operatively, sitting the patient upright is imperative to assess the repair and degree of symmetry. Patience is important as multiple trials of suturing may be necessary to achieve satisfactory repair and symmetry.
Post-operatively, the use of tape is used to apply pressure on the previously elevated skin overlying the sternum. Compressive dressings and a pressure bra are also helpful.
You may also find the attached link helpful to you.
Implants appear too low and too close together
Thank you for the photo and it sounds like you have done some research already. I agree that your breast implants are too low and too close together. The capsule contracture diagnosis would be based on your history as well as examination. Revision and repair of these issue would involve removal of the capsule if there is capsule contracture. A strip of capsule may be maintained to use in the repair of your breast pocket near your sternum (in between your breasts) to repair the symmastia. Similarly the pocket at the bottom of your breasts would need to be tightened. You will need new implants and you may entertain the idea of having drains after this for 2-3 days just to help with the inflammatory process. I have attached a link of one of by breast revision patients before and after photos who underwent a similar operation.
All the best,
Dr Remus Repta