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Symmastia Repair Surgery ~ Uni-boob Repair
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Symmastia Repair

Symmastia (or medial mal-position or “uni-boob”) occurs when the breast implants move too far toward the midline -the two implants may actually touch one another in the center of the chest. If the horizontal 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 for 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 sub muscular implant placement allows the muscle to provide some softening of the transition to the cleavage area from the augmented breast mound. Correction involves use of internal sutures of the capsule around the breast implants.  Often, it is necessary to expand the breast implant pocket laterally (outwardly) to allow for correct placement of the implants.

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This 26-year-old patient from San Diego, CA. had her first breast augmentation in 2005. She noticed mal-position of her breast implants and came to Dr. Pousti for a consult regarding symmastia repair in 2007. Dr. Pousti performed breast reconstructive surgery in June of 2007. She is now post-op surgery with saline implants, filled to 330 cc on the left and 330 cc on the right made by the Inamed Corporation and pleased with her initial results. 
  

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Your browser may not support display of this image.  This 23-year-old patient from San Diego, CA. had her first breast procedure in 2005. She noticed mal-position of her breast implants and came to Dr. Pousti for a consult regarding symmastia repair in 2007. Dr. Pousti performed breast reconstructive surgery and corrected her symmastia in March of 2007. She is now 6 months out of surgery and is very happy. She has 450cc saline breast implants.

    Symmastia Repair

    

Your browser may not support display of this image. Specific dressings and bra are used to reinforce the repair. The bra that is worn after symmastia repair is referred to as the "thong bra". It is used to stabilize the area after symmastia reconstruction. This will allow the sutured area between the breasts to heal properly without excessive pressure being applied to the area. 


 

 

Symmastia Correction Information  

Medial confluence of the breasts, known as symmastia, occurs when two breast implants touch or are very close to one another in the center of the chest just above the sternum in the cleavage area. This occurrence, which can produce a web across the midline, is commonly referred to as bread loafing or uniboob, giving the appearance of tow breasts connected underneath the skin as the skin and tissue is pushed up. A possible consequence of unopposed muscle action with overzealous medial release causing aesthetic disfigurement and additional issues with discomfort and apparel problems, symmastia is a difficult surgical complication to address.

Patients with multiple breast operations, excessively large implants or overaggressive medial dissection are susceptible to developing symmastia. Symmastia seems to be more prevalent among thin women mainly due to the fact that thin women usually have less tissue or fat covering the sternum. Also, patients with pectus excavatum, a depressed breastbone, are more prone to symmastia. Pectus excavatum may cause the implants to slope inward, toward the cleavage area, creating more pressure on the tissues in that area, resulting in symmastia. Attempts to increase cleavage by releasing the soft tissues or inner origins of the pectoralis muscles lead to symmastia by surgically interrupting the natural barriers of tissue and muscle at the medial location of the breasts where the cleavage is normally defined. For instance, if the horizontal muscle, which lies on top of the sternum dividing the implants, is cut, then the possibility of the implants settling towards the middle of the chest is increased. This complication may occur when implants are placed either underneath or above the pectoral muscle.

Symmastia is difficult to treat and recurrence is common. Correction requires combined restoration of the initial presternal subcutaneous integrity and medial closure of the pocket. In order to repair symmastia, the space between the 2 implants must be securely closed off.  The combination of medial closure of the breast implant pockets and suturing of the preseternal soft tissue to the sternum periosteum provides one satisfactory option to the surgical reconstruction of symmastia. Often, it is necessary to “open” the breast implant pocket laterally (to the sides) to decrease pressure along the cleavage area. There are several methods used to correct the deformity, such as allogenic dermal grafting, fibrin-based tissue glue, and delayed filling of an adjustable implant.

Before the surgical procedure, careful markings are done with the patient in the upright and laying position. Often, symmastia co-exists with other breast implant malposition problems and breast asymmetry. These issues should be addressed as well. 

Your browser may not support display of this image. Your browser may not support display of this image.In the operating room, the implants are removed and the external drawings are transposed internally with needle and dye technique (tattoo).  This allows accurate placement of sutures to close off the overly expanded breast implant pocket. Prior to suture placement, however, the excess breast implant pocket capsule (scar) is removed (capsulectomy). This creates a “raw” surface that may help with tissue adhesion/scar formation and decrease the risk of re-occurrence of the symmastia. The edges of capsule remaining are sutured to one another (capsuloraphy). Often, a “mirror image” capsulectomy is required to expand the pocket laterally, decreasing pressure on the symmastia correction and improving appearance and position of the nipple-areola on the breast mound.  A temporary breast implant sizer is placed and inflated to assess for correct positioning of the sutures and correction of the implant malposition. 

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Once satisfactory correction / appearance are achieved, additional sutures are placed for reinforcement of the repair. Finally, the implants are inserted and placed back in to the new pocket and the incision is resutured.    

  Symmastia Repair

Your browser may not support display of this image.After corrective surgery, the patient is instructed to wear a t-back sports bra or “thong bra” for at least two months. This brassiere is utilized to help apply pressure and assists in keeping the area stable allowing the area to heal and aiding in recovery. After this specific surgery, patients are extremely careful to allow for full recovery.

 

 

   


Below are some of Dr. Pousti's symmastia correction patients who are very happy with their results

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This 21 year old patient from Bonita, California came to see Dr. Pousti for revisionary surgery. She had gone to Mexico for her first surgery and ended up with symmastia of the breasts. Symmastia - commonly referred to as "breadloafing" or "uni-boob", occurs when two implants touch one another in the center of the chest. If the horizontal 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 results from overly aggressive attempts to alter chestwall 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. She wanted a good cosmetic surgeon in San Diego who was board certified and found Dr. Pousti. She has just recently gone through symmastia reconstruction and is allowing us to show her progress. 

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This 30-year-old patient from Claremont, California has come to Dr. Pousti in need of revisionary surgery of her breast implant placement. Symmastia - commonly referred to as "breadloafing" or "uni-boob", occurs when two implants touch one another in the center of the chest. If the horizontal 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 results from overly aggressive attempts to alter chestwall anatomy trying to increase cleavage in patients. This patient is 2 months post-op correction of her symmastia and bottoming out, removal of breast implants and breast reaugmentation surgery with 600 cc silicone gel implants made by the Mentor Corporation.  

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This 25 year old patient from Palm Desert, California had her first breast augmentation surgery performed in Mexico.  A few months after getting her breast implants, she noticed that she had developed symmastia (the implants were touching down the mid-line) and her implants were bottoming out. She had a uni-bood (as some call it).  The patient was extremely upset about the results and worried about having revisionary surgery. Symmastia - commonly referred to as "breadloafing" or "uni-boob", occurs when two implants touch one another in the center of the chest. If the horizontal 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 results from overly aggressive attempts to alter chestwall 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. She found Dr. Pousti through her sister who had surgery and was very pleased with her results. She had bottoming out of both breast implants, encapsulation of both sides (left > right), and the areola were displaced laterally on both sides. This patient is ONLY 1 week and 3 months out of surgery so there is still some bruising and swelling but we can see what an amazing result she achieved. This patient chose to have silicone gel implants. She is VERY HAPPY with her results. 

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This 26-year-old patient from San Diego, CA. had her first breast augmentation in 2005. She noticed mal-position of her breast implants and came to Dr. Pousti for a consult regarding symmastia repair in 2007. Symmastia - commonly referred to as "breadloafing" or "uni-boob", occurs when two implants touch one another in the center of the chest. If the horizontal 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 results from overly aggressive attempts to alter chestwall 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. Dr. Pousti performed reconstructive surgery in June of 2007. She is now post-op surgery with saline implants, filled to 330 cc on the left, and 330 cc on the right made by the Inamed Corporation and pleased with her initial results. 

Symmastia Repair

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This 23-year-old patient from San Diego, CA. had her first breast procedure in 2005. She noticed mal-position of her breast implants and came to Dr. Pousti for a consult regarding symmastia repair in 2007. Symmastia - commonly referred to as "breadloafing" or "uni-boob", occurs when two implants touch one another in the center of the chest. If the horizontal 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 results from overly aggressive attempts to alter chestwall 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. Dr. Pousti performed reconstructive surgery and corrected her symmastia in March of 2007. She is now 6 months out of surgery and is very happy. 

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This 28-year-old patient from Bellflower California (Los Angeles Area) has had 3 pervious breast augmentation surgeries. Her original surgery was 9 years ago in Mexico. Unfortunately she has developed symmastia. She had come to Dr. Pousti for correction of her symmastia. This patient is 2 months post-op correction of symmastia, breast reaugmentation with silicone gel implants filled to 400 cc on both the left and right side made by the Mentor Corporation. This patient is very happy with her results. 

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This 20-year-old patient from Orange, California (Orange County)  came to Dr. Pousti with symmastia. Symmastia - commonly referred to as "breadloafing" or "uni-boob", occurs when two implants touch one another in the center of the chest. If the horizontal 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 results from overly aggressive attempts to alter chestwall anatomy trying to increase cleavage in patients.  This patient needed revisionary surgery of her breast implant placement.  Dr. Pousti has removed her breast implants, corrected her symmastia and replaced her breast implants with 450 cc silicone gel implants made by the Mentor Corporation. This patient pictures have been taken in the OR, as she continues to heel we will update her pictures.

 Symmastia Repair

Symastia Repair Before and After Photos

Symastia Repair Photos by Plastic Surgeon, Dr. Teitelbaum, Santa Monica, CA

Symastia Repair Photos by Plastic Surgeon, Dr. DeWire,
Richmond, VA

Synmastia Repair Photos - Breast Revision Set 8 
by Dr. Revis, Fort Lauderdale, FL

Dr. Revis Synmastia Info

Synmastia (aka uniboob, breadloafing) is a specific example of a postoperative problem requiring a thorough, systematic approach and innovative surgical techniques. This is one of the most dreaded complications following breast augmentation, and the permanent correction of Synmastia is one of the most difficult problems facing a plastic surgeon. This is why it is critical that you find a plastic surgeon with extensive experience in the correction of Synmastia and one who is confident in his or her own technique.

What is Synmastia?

Synmastia (shown below) is present when one or both implants are positioned too close to the midline over the breastbone (sternum). This means that the pockets, or capsules, surrounding the implants are too medially placed.

This most often represents overdissection of the pocket in the region of the cleavage during surgery.

The worst case Dr. Revis has seen is one in which the breasts had one capsule that was continuous from one breast to the other. In other words, the implants could both be squeezed into the right breast side of the pocket or they could both be squeezed into the left breast side of the pocket. The opening in the middle between the two pockets was approximately three inches in diameter.

What are the symptoms of Synmastia?

Many patients report that their Synmastia is accompanied by a mild discomfort in the midline with or without rippling.

How is Synmastia diagnosed?

Symnastia is usually diagnosed by the patient or by a plastic surgeon. An experienced plastic surgeon should be able to diagnose most cases of Synmastia from photos alone.

When diagnosing yourself, you may find that your breasts touch in the middle, that the skin has lifted off of the breastbone (sternum), or that there really is no separation between the breasts because the skin tents from one breast to the other.

When you push your finger down onto the breastbone in the middle of your chest, your implants may separate but then spring back towards one another when you remove your finger. You may also notice that when you bend forwards and look between your breasts there really is no indentation in the midline between the breasts.

Proper implant position means that the nipple is centered on the center of the breast implant. If more of the implant rests medial to the nipple than lateral to the nipple, then you may have Synmastia. When this nipple-implant malposition occurs, it may make the nipples appear to point outwards (called walleyed) or may make the nipples appear to be too far apart. This appearance results from the fact that as the implants migrate medially the nipples rotate outwards, giving the walleyed appearance.

Can Synmastia be corrected non-surgically?

Unfortunately, in Dr. Revis’ experience he has found that the Internal Bra procedure is required to correct Synmastia. Synmastia may be temporarily camouflaged in clothing using a separator bra, but this does not create any permanent solution to the problem.

Will switching to smaller implants correct Synmastia?

Switching to smaller implants alone will not correct Synmastia. Synmastia is a pocket problem, not an implant problem. In my experience the only true, long term correction for Synmastia is an Internal Bra procedure.

How can Synmastia be corrected?

Dr. Revis has developed a special technique that has the effect of creating an Internal Bra using strong, permanent suture techniques. Using special lighted retractors, Dr. Revis expands the implant pockets (capsulotomy) superiorly and laterally, creating room for the implants to be repositioned further apart in the midline- creating better separation and a more pleasing appearance.

Dr. Revis then closes the part of the pockets that rests too medially over the sternum using the Internal Bra. This repairs the connection of the overlying skin and muscle to the underlying breastbone or sternum thus preventing the implants from resting too close to one another in the middle of the chest. Dr. Revis uses permanent sutures for a long-lasting result. These sutures are carefully placed so that the suture material is never in direct contact with the implants inside the body.

May I switch to larger implants when I have my Synmastia corrected?

Absolutely. Approximately 40% of Internal Bra patients keep the same size implants, 40% increase the size of their implants, and the remaining 20% reduce the size of their implants. The size/weight of the implants has no relationship to the success or the long-lasting nature of the Synmastia repair with the Internal Bra when it is performed correctly with permanent sutures.

May I see examples of the Internal Bra procedure for the correction of Synmastia?

Please click the link below to visit my Breast Augmentation Revision Main Page to review pre- and post-operative photos of the Internal Bra for Synmastia as well as numerous examples of other breast implant problems.

Symastia Repair Before and After Photos

Symastia Repair Photos by Plastic Surgeon, Dr. Teitelbaum, Santa Monica, CA

Symastia Repair Photos by Plastic Surgeon, Dr. DeWire,
Richmond, VA

Synmastia Repair Photos - Breast Revision Set 8 
by Dr. Revis, Fort Lauderdale, FL

 

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