Is this symmastia and what are you suggestions of loose skin? (Photos)

Question

Initially subglandular (19 years) no loose or raised skin on sternum or extra folds at cleavage. 2015 dual plane significant animation/window shading and now subfascial. Any suggestions for loose skin, over dissected pectoral muscle/pockets and window shading? Do I have symmastia?

Anoush Hadaegh, MD · Answer

Hello,
Thank you for your question. You have a very difficult and rare problem in breast augmentation surgeries. It seems like that medially you have lost the connection of the pectoralis  muscle to your breast bone. So the corrective procedure is to imitate that connection. This could be done with the combination of suturing the capsule of the breast implant to the breast bone with possible further reinforcement of the area with mesh or acellular dermal matrix. After the operation you need a special garment to wear for 3-6 months and avoid certain activities for 6 months. I recommend you to be evaluated by a board certified plastic surgeon who does a good amount of revision breast procedures. Good Luck!

Daniel Barrett, MD · Answer

Dear SalSilBR,
symmastia is a rare breast condition that occurs when soft web-like breast tissue pulls breast implants towards each other, until the breasts meet uncomfortably at the center of the chest near the sternum (the body’s midline point). Given this abnormal union, symmastia is known by many other names, including breadloafing, kissing breast implants, and the uniboob.Unfortunately, this condition causes the surrounding skin and pectoral muscles to literally lift off the breast bone as the implants are pulled together. This consequently causes pain and discomfort, as well as obvious distortion of the breasts, which can only be disguised with clothing that does not show cleavage.You should consult with a board certified plastic surgeon for proper assessment. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Tom J. Pousti, MD · Answer

I have read some of your extensive history on Real self and am sorry that you have had significant problems after breast surgery. It is hard for online consultants ( without much more history in your complicated case) to provide you with specific enough advice to be truly helpful.  As you have noted in your posts, a review of your previous operative reports would be helpful. Having said that, improvement of your outcome will likely be achieved with revisionary breast surgery involving techniques such as medial capsulorraphy and the use of acellular dermal matrix.In my practice, having used a variety of “techniques” for correction of symmastia or medial implant malposition, 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.
 
 Best wishes.

Is this symmastia and what are you suggestions of loose skin? (Photos)

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