Internal Bra procedure, why don't doctors in Canada do this? (Photo)

Thank you for the question and pictures. I am sure that you will find well experienced board-certified plastic surgeons in Canada who will be able to help you if you are experiencing breast implant malposition concerns. I would agree with your understanding that it is not mandatory to decrease breast implant size;  careful intraoperative measurements (dimensional planning) is important when it comes to deciding what breast implant size/profile can be used safely after capsulorraphy techniques have been carried out. Of course, careful preoperative education will also be important. When planning these procedures, I caution patients that our primary goal should be long-term stable correction of the breast implant malposition/displacement problem. Size concerns are secondary.  Fortunately, most patients are able to achieve BOTH improvement in breast implant positioning and achieve their size goals as well.  I hope this, and the attached link ( dedicated to revisionary breast surgery concerns) helps. Best wishes.

The base diameter of the implants is more important than the size (volume) of implants when correcting symmastia, because if the diameter is too wide then moving the implants farther apart would push them into your armpits. For that reason statistics about other patients are not relevant to your specific situation and offering useful advice would need to be based on your measurements and preferences. Permanent sutures also do not make a difference in my opinion because it is the strength of the tissues being sewn that determines long-term success. The internal bra using Alloderm, SERI Scaffold silk, or GalaFLEX mesh is very helpful in providing tissue support. Strattice is also very useful but I don't believe it is available in Canada.

Symmastia is the result of dissecting the pocket to close to the midline.  This error maybe the result in trying to create medial cleavage, implants that are to wide for the chest or stretching of the tissue.  It is best avoided.  Changing implant location, medial capsulorrhaphy (reducing the medial extension of the pocket) can correct the problem.   The strength of the repair is more based on the strength of the capsule rather than the use of permanent sutures.  Alloderm is used in Canada.  The product is expensive and not covered by provincial health plans.  It is often not necessary to use alloderm for the correction of symmastia.