I am sorry to hear about your development of symmastia. This is cause by two different things - over dissection during surgery or implants that are too big for the existing breast pocket. When your implants are subglandular, the best way to correct this is to convert to sub muscular. This is an easy thing to do and the muscle edges will prevent the implants from coming together. You then need to tailor the pocket/ breast to accommodate the new position. This involves securing the breast tissue back down to the muscle (like it is naturally), as well as reinforcing the soft tissues for added support. I would not worry so much about a double bubble deformity. When done correctly, this should not be an issue. With symmastia, you want to make sure that your surgeon is very experienced with complex breast revisions. Otherwise, seek out ones that are. I hope this helps.
Symmastia or loss of midline cleavage is one of there most difficult problems to correct in aesthetic breast surgery. It can occur due to over dissection of the breast pocket medially or large implants which can obliterate the midline contour of the breast.I agree with you surgeon's plan to place the implant in a subpectoral location and use ADM (alloderm, strattice, etc) to support the lower breast. Done properly, I think your breast will look and feel better. I think the risk of a double bubble is very low. Good luck.
Symmastia repair over the muscle?
I am sorry to hear about the complication you have experienced. You will find that there is no way to generalize exactly what is involved in symmastia corrective surgery and exactly what the recovery experience will be like. There will be lots of variation from one plastic surgeon to another, and from one patient to another.
You will be better off, in this regard discussing the planned operation and the expected recovery with your chosen plastic surgeon.
In my practice, having used a variety of “techniques” for correction of symmastia, I find that the most reliable technique involves a 2 layer capsulorrhaphy (internal suture repair of the breast implant pockets along the cleavage area). Often, the use of acellular dermal matrix is helpful also. I have also been pleased with the (at least partial) correction of skin tenting that can be achieved with the use of the acellular dermal matrix.
Often, it is necessary to “open” (reverse capsulotomy) 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.
I also find that careful attention to postoperative activity restrictions is key to success with this type of surgery and other types of implant malposition revisionary breast surgery.
Again, your plastic surgeon will be your best resource when it comes to more specifics. You may find attached link helpful to you when it comes to more general symmastia corrective surgery concerns. Best wishes for an outcome that you will be very pleased with.