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Case Number 4857: Symmastia Correction with BioSynthetic Mesh

This 24 year old healthy female from Costa Mesa, California had previously had breast augmentation surgery with 350cc breast implants (performed by another surgeon). The patient presented with significant breast implant mal-position medially and inferiorly (the breast implants were displaced too low and too far toward the cleavage area), therefore causing the nipple-areolar complexes to be off centered and pointing outward. before implant exchange and capsulorrhaphy to close off breast pocket and prevent symmastia and use of tigr matrix mesh for support

She was unhappy with her results and desired her breast image to be corrected. She began a google search for a board certified plastic surgeon who had experience in symmastia repair and came across Dr. Pousti. Symmastia – commonly referred to as “bread-loafing” 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 chest wall anatomy trying to increase cleavage in patients. This outcome is made worse by use of larger implants in thin patients.

pre-op implant exchange and capsulorrhaphy to close off breast pocket and prevent symmastia and use of tigr matrix mesh for support

She scheduled a consultation and had the opportunity to speak with Dr. Pousti regarding the options to correct her implant displacement along with the possible risks and complications associated with any surgery. For this patients specific case, she and Dr. Pousti discussed her symmastia, her breast asymmetry, her bottoming out and the combination of capsulorrhaphy (placement of internal permanent sutures) and the use of additional supportive material such as Strattice or BioSynthetic Mesh were discussed.

side view before implant exchange and capsulorrhaphy to close off breast pocket and prevent symmastia and use of tigr matrix mesh for support

Dr. Pousti decided to use TIGR Mesh which is a BioSynthetic mesh that is non-human / non-pig but will provide additional support for this patient’s breast pocket repair.  The measurements and markings are performed on the morning of the surgery and Dr. Pousti reviews all the procedures that will be performed.

markings for implant exchange and capsulorrhaphy to close off breast pocket and prevent symmastia and use of tigr matrix mesh for support

The red shaded area shows where the breast pocket is going to be closed off through capsulorrhaphy. The capsulorrhaphy procedure, also known as pocket correction or use of internal sutures/bra, involves closing a portion of the breast pocket to correct displacement of the implant.

implant exchange and capsulorrhaphy to close off breast pocket and prevent symmastia and use of tigr matrix mesh for support

Below shows the right breast after capsulorrhaphy. The intra-operative sizer is used to assist Dr. Pousti in determining the best sized implant to help the patient achieve her goals.

sizer for implant exchange and capsulorrhaphy to close off breast pocket and prevent symmastia and use of tigr matrix mesh for support

The Tigr Matrix Mesh is used to help add additional support to the breasts. Tigr Matrix surgical mesh is a degradable surgical matrix made from synthetic resorbable polymers intended to support and reinforce tissue for 6-9 months and be absorbed completely by the body after 3 years.

implant exchange and use of tigr matrix mesh for support. capsulorrhaphy to close off breast pocket and prevent symmastia

The patient is shown below immediately after breast revision surgery surgery. She has bilateral 415cc high profile Sientra silicone gel breast implants.

before and after implant exchange and capsulorrhaphy to close off breast pocket and prevent symmastia and use of tigr matrix mesh for support

The bolster dressing is used as a support between the breast implants to assist in preventing a recurrence of implant displacement.

after implant exchange and capsulorrhaphy to close off breast pocket and prevent symmastia and use of tigr matrix mesh for support



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Pousti Plastic Surgery Center
Pousti Plastic Surgery of San Diego
8851 Center Drive, Suite 300
La Mesa, California 91942
Phone: (619) 466-8851 or Email
 
Dr. Tom Pousti is a San Diego and La Jolla Plastic Surgery specialist. He has provided plastic surgery treatments to many San Diego and La Jolla facelift, tummy tuck, liposuction, breast augmentation, and rhinoplasty patients. His office is located in San Diego, and also serves the La Jolla, Riverside, Inland Empire and Temecula areas. Disclaimer


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