Can permanent sutures for symmastia repair be removed? Where are they typically placed?

Yes, permanent sutures placed at the time of symmastia repair can be removed and you will not have any adverse effects afterwards. If you are undergoing explant then I recommend a simultaneous lift. The technique I recommend 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.

Best Wishes,

Gary Horndeski, M.D.

Hello, thank you for your question. Symmastia repair is a complex surgery that involves repositioning the breasts to correct the condition where the breast tissue merges across the midline, often due to implants. Permanent sutures are sometimes used to hold the tissues in place after the repair, and I understand your concerns about the potential for these sutures to be removed during your explant surgery. Please see the attached video to answer your question. While permanent sutures from symmastia repair can be removed during explant surgery, whether or not they should be removed will depend on how well the tissue has healed and the surgeon's assessment of the repair. Your surgeon will likely take great care to ensure the repair remains intact and that no damage occurs to the chest wall during the process. Be sure to discuss your concerns in detail with your surgeon to create a plan tailored to your situation.

Thank you for your question. I would say that any permanent sutures in place could be removed at the time of surgery. But the point of using a permanent suture is to provide long term strength or support. So once those sutures are removed, you are relying on residual scar tissue in the area to hold things together and there is no assurance that will be enough. There is no "typical" amount or placement of sutures as every physician has his or her own preference for what they do and what works in their hands. It would be best to obtain a copy of the operative report for review by your new surgeon. In the end, my biggest question is, why do the sutures need to be removed? Generally speaking, permanent sutures are made of materials that do not generate any inflammatory response (like a dissolvable suture) because they are made of inert material, so I do not think they need to be removed.
Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

The only evidence we have regarding the relationship of silicone gel breast implants and autoimmune disease is that there is no connection whatsoever. You do not need to remove your implants; it will have no impact on your illness. From the line of your questioning, it sounds like you've been reading misleading information about getting all the scar our and anything that may be harboring 'toxic' substances like the suture. This is wholly unnecessary. Reconsider keeping your implants, they are not the source of your autoimmune disease nor will they ever cause you any other disease.

If implants are coming out your surgeon may be able to remove the sutures if they're easy to find. If the sutures aren't causing a problem, hunting for them when they're hard to find or see can cause more problems and inflammation and disrupt skin adherence to the chest wall.

Permanent sutures are not typically removed during explant. Your surgeon may be able to remove them if they are easily accessible, otherwise there is a risk that greater damage will be done in searching for them. I encourage you to discuss your concerns with your surgeon for further understanding.

Exposing the deep sutures and removing them will require more invasive surgery and is inherently unnecessary.
There is no evidence whatsoever that permanent sutures cause long-term problems, unless they are contaminated or are by themselves creating problems
I suggest you have a conversation with your plastic surgeon who’s going to remove the implants to see if they are amenable to making an attempt at removing the sutures. Perhaps it’s a decision best made in the operating room where the surgeon can decide how much extra dissection is appropriate without causing undue harm.
Individuals who have anxiety about things like implant, illness, or foreign bodies creating health concerns are more likely to have symptoms and continue worrying about them. It is in the sense of self fulfilling, prophecy. If you think things like permanent sutures are causing you ill health then you’ll probably continue to associate having the sutures with not feeling well.
For those who don’t have these concerns, they generally are symptom-free and go on to live a normal life.
Auto immune disease is fairly common, and most people who develop auto immune disease do so with or without having had implants or permanent sutures.
Talk to your plastic surgeon who is the best and most appropriate person for you to discuss your concerns with.
Best,
Mats Hagstrom, MD