Symmastia Patients

This 22 year old patient from San Diego, California had breast augmentation surgery performed by a previous surgeon and was left with unsatisfactory results. The patient was not happy with the overall appearance of her breasts but the breast shape bothered her the most. She did not feel comfortable returning to her previous surgeon and knew that she would have to do research to find a surgeon that was experienced with revisionary breast surgery. During her search she came across Dr. Pousti several times and was very impressed with the vast amount of experience he had with breast revision procedures.

Upon examination it was apparent to Dr. Pousti that the patient had a severe case of ‘Symmastia’. Symmastia occurs when the skin near the cleavage area separates from the sternum; causing the implants to be malpositioned medially. This can cause the breasts to form a ‘bread-loaf‘ appearance.

The patient and Dr. Pousti meet several times prior to the revisionary breast surgery to discuss options and go over the procedure in detail. In this patient’s case the best option was to go with symmastia repair and an implant exchange. The first step of this surgery is to take measurements of the patients chest and mark the areas where correction is needed.

When the patient is in the operating room she is placed in an upright position and markings are re-checked. If any adjustments are needed they are done at this time. The red area indicates where the symmastia repair will need to be done.

The patient’s current breast implants are taken out through a small incision along the areola. To avoid additional scaring the previous incisions were re-used. Once the implants are removed Dr. Pousti begins work on the ‘breast pocket’. A breast pocket is an open pocket created under the muscle where the breast implants sits.

During symmastia repair Dr. Pousti uses internal sutures to re-attach the skin to the sternum in the center of the patient’s chest. Sizers are then used to determine the size of the implant Dr. Pousti will need to use in order to achieve the patient’s desired look.

300cc Silicone Gel Implants were used in both breast to meet her goals.

As you can see when the patient is in a lying down position the symmastia correction has improved the appearance of the chest and the patient no longer has ‘tenting‘ present.

After the procedure is completed, bolster dressings are applied. The dressings help add support to the internal sutures and help ensure that implant malplacement does not reoccur.

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A “thong bra” is then given to patient to wear post surgery and 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.

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Posted in Breast Augmentation, Breast Pocket Correction, Breast Procedures, Breast Revision Surgery, Silicone Gel Implants, Symmastia

This 30 year old from Apple Valley, California was interested in revisionary breast surgery. She was unsatisfied with her results from her previous surgeon. She did not like the shape, size, or placement of her breast implants and she also suffered from implant malposition resulting in symmastia. She researched the internet for experienced breast revision surgeons and found Dr. Tom Pousti. After reviewing many symmastia and breast revision repair cases, she felt optimistic that he would be able to achieve the same results with her and decided to drive to see Dr. Pousti.

Upon examination, Dr. Pousti determined the patient not only had symmastia, but “bottoming out” of her implants as well. Symmastia appears when two implants are touching one another often creating a “uni-boob”. Symmastia often happens if the horizontal muscle that is connected to the sternum is cut during surgery and after overly aggressive attempts to achieve cleavage are made.

The patient and Dr. Pousti met again to discuss the procedure in detail along with recovery. Markings were done the night prior to surgery and were reinforced the morning of surgery. In order to achieve her desired look, internal sutures were used to repair her cleavage area and to also create an “internal bra” for the new position of the implants and to fix the bottoming out of the implants.

Dr. Pousti removed the patient’s previous implants through a small incision of the areola.

Immediately After Symmastia and Bottoming Out Repair

He replaced the patient’s previous implants with 475cc Silicone Gel Breast Implants. After repairs were made, the patient has two distinct breast pockets.

Bolster dressings are worn for several weeks to protect the repaired area during recovery.

The patient is very happy with her results.

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Posted in Breast Augmentation, Breast Procedures, Breast Revision Surgery, Internal Bra (Internal Sutures), Silicone Gel Implants, Symmastia

This 41 year old patient from Price, Utah had 2 breast procedures performed previously by another surgeon and was still unhappy with her results. The patient didn’t feel comfortable returning to her previous surgeon and decided to do more research to find a Plastic surgeon with expertise in revisionary breast surgery. While doing research online she came across board certified plastic surgeon Dr. Pousti and was impressed with his revisionary breast surgery experience.

During the examination it was apparent that the patient had breast implant malposition and symmastia. Symmastia, commonly referred to as ‘uni-boob’ or ‘tenting’, occurs when the implants touch in the center of the chest. In order for symmastia correction to take place internal suturing must be done.

Before symmastia repair can be done the patient’s current breast implants are removed. Dr. Pousti generally uses the same incision sites to prevent additional scars.

Dr. Pousti uses internal suture to re-attach the muscle vertically to the sternum. Before the actual sutures are used markings are made to indicate where they must be.  It was discussed in detail that “skin tenting” is difficult to correct and sometimes when the breast implant mal-position is corrected, the “tenting” may remain.

The patient had her breast lift revised, re-augmentation with silicone gel implants, areolar reduction and correction of symmastia.

She is very happy with her initial breast procedure results.

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Posted in Breast Lift with Implants, Breast Revision Surgery, Internal Bra (Internal Sutures), Symmastia

This 27 year old patient from Ohio had been in communication with Dr. Pousti’s office regarding her interest in revisionary breast surgery and specifically correction of her symmastia. The patient had her original breast augmentation performed in 2006 and symmastia correction in 2008 with a previous surgeon. She was left unhappy with her results and decided to do more research to find a qualified surgeon with experience in breast revision surgery.

Symmastia occurs when the muscle between the implants lifts from the sternum causing a ‘breadloafing’ or ‘uniboob’ look.

Prior to the procedure the patient is examined by Dr. Pousti who then takes measurements and does the markings. Markings along with the entire symmastia repair procedure are reviewed with the patient in detail.

The red markings between the breast indicate where the symmastia is present and where correction must take place. To correct symmastia Dr. Pousti sutures the muscle back to the sternum internally.

In some cases, like this patient, the pectoral muscle is very damaged and allograft is needed to help cover the implant.

Symmastia correction can take anywhere from 2-3 hours depending on the complexity of the case.

Patients are asked to bring in pictures of their desired goals which are used in the operating room in conjunction with sizers to determine the size of the implant needed.

Before/After Symmastia Correction

This patient is post op removal of old breast implants, correction of symmastia with the use of internal suturing and allograft and re-augmentation with silicone gel implants.

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Posted in Breast Pocket Correction, Breast Procedures, Breast Reconstruction, Symmastia

This 41 year old patient from Arizona had breast augmentation surgery in 1992 and again in 2002 by a previous surgeon in her home town. The patient developed symmastia, also know as ‘bread loafing’. Symmastia occurs when two implants touch one another in the center of the chest. 8 years later she decided to proceed with revisionary breast surgery to correct her symmastia and to add volume to her breasts. The patient found Dr. Pousti online and ultimately decided he was worth the travel to San Diego, California due to his experience with breast reconstruction surgery.

The patient met with Dr. Pousti and his staff the day before surgery in his office. The entire breast revision procedure was reviewed in detail with the patient and markings were made.

The red arrows indicate where the patient desires more fullness and the red portion that is colored in the middle is where the symmastia repair will take place.

Once the patient is in the operating room she is placed in an upright position and her measurements and markings are re-checked.

After implants are removed the symmastia repair portion of the surgery is performed. In order to correct this patient’s implant malposition Dr. Pousti used internal sutures to re-attach the muscle back to the sternum. This is also knows as ‘pocket correction’. Once symmastia repair is completed sizers are used to determine the size of implant needed to achieve the patient’s size goals. To achieve this patient’s desired look a 800cc Saline implant overfilled to 920 was used in her right breast and a 800cc saline implant overfilled to 820 was used in her left.

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. This is more noticeable when the patient is in the prone (laying down) position.

Before

Immediately After Surgery

Bolster dressing is placed immediately after and is to be worn along with a ‘thong bra’ for 1 month to stabilize the area and help prevent symmastia occurrence.

The patient is extremely pleased with her initial results.

Click here to see full details on this patient

Posted in Bottoming Out, Breast Asymmetry, Breast Procedures, Breast Reconstruction, Breast Revision Surgery, Internal Bra (Internal Sutures), Overfilled Saline Breast Implants, Symmastia

This 29 year old female from Honolulu, HI had breast augmentation in the Philippines in 2005 which caused her to develop symmastia. Symmastia occurs when the muscle is separated from the chest wall. When the separation is present the implants touch causing a ‘uni-boob’. 3 years later the patient had breast surgery performed again by her previous surgeon in an effort to correct her symmastia. Unfortunately it is not guaranteed that the symmastia will not reoccur after repair, especially with surgeons that aren’t specialized in this type of reconstruction. In this patient’s case the symmastia repair performed by her previous surgeon did not help and the patient decided to do more research on surgeons that specialize in revisionary breast surgery and symmastia repair. During her search she came across Dr. Pousti and was very impressed with his experience in symmastia repair.

During symmastia repair Dr. Pousti uses internal sutures re re-attach the muscle to the chest wall. Dr. Pousti also wanted to create more upper fullness on the right breast as well to achieve bilateral symmetry.

When the patient is in the prone position the presence of symmastia is even more visible. There is malposition of the nipple/areola complexes due to the symmastia.

After all measurements are markings are done the patient’s current breast implants are removed so that internal suturing can begin.

Along with internal sutures, Dr. Pousti will use AlloDerm. AlloDerm is donated tissue used for revisionary breast surgeries in patient that have thin skin.

Once the symmastia repair is performed a 371cc Silicone implant was placed in the left breast and a 397cc Silicone implant was placed in the patient’s right breast.

Bolster Dressing, consisting of a layer of gauze, is placed to secure the symmastia repair site.

Before

Immediately After Surgery

After surgery with Bolster Dressing and Support Bra

The patient is extremely happy with her results and is very thankful that she found Dr. Pousti.

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Posted in AlloDerm, Bottoming Out, Breast Pocket Correction, Breast Procedures, Breast Reconstruction, Breast Revision Surgery, Implant Removal, Internal Bra (Internal Sutures), Symmastia

This 25 year old patient from Arizona had breast augmentation performed in 2000 by a surgeon in her hometown. After several years she was still unhappy with her results and started doing research on revisionary breast surgery. During her search she came across Dr. Pousti and was very impressed with his experience in reconstructive surgery.

After examination it was determined that the malposition of the implants was due to mild symmastia. Symmastia, also know as the ‘uni-boob’, is a condition in which the muscle separates from the sternum and causes the implants to touch. Symmastia results from overly aggressive attempts to alter chest wall anatomy trying to increase cleavage in patients. Unfortunately the only way to reverse this is via reconstructive surgery.

Markings and measurements are performed prior to surgery. The red areas indicate where the muscle has separated from the sternum and need to be repaired.

Dr. Pousti uses internal sutures to correct the breast pockets and reattach the muscle to the sternum.

After some markings are made small incisions are made and the old implants are removed. Once the implants are removed additional markings are made to indicate how much space the patient desired in her cleavage area.

Proceeding the internal suturing new implants are set in place and the patient is evaluated so that necessary adjustments can be made.

Before and Immediately After the surgery – laying down. As you can see the areola are no longer pointing off to the sides because implants are no longer touching.

Immediately after surgery a bolster dressing is placed and is to be worn along with a ‘thong bra’ for 1 month to stabilize the area and help prevent occurrence.

Click here to see full details on this patient

Posted in Breast Revision Surgery, Symmastia

This 36-year old out-of-town patient was interested in revisionary breast surgery. The patient is status post breast augmentation surgery in 2003 and revisionary breast surgery in 2003 and again in 2009.

Due to symmastia and rippling, the patient was very unhappy with the results of her surgery and she experienced pain on the sternum area.

The patient researched for a Board Certified Plastic and Reconstructive Surgeon who is experienced in symmastia repair to perform her breast revision surgery. The patient found Dr. Pousti on the Internet after reading excellent reviews she called to discuss her case. The patient knew Dr. Pousti was the best surgeon for her.

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 chestwall anatomy trying to increase cleavage in patients. This outcome is made worse by use of larger implants in thin patients.  The “red marks” above are where Dr. Pousti will be placing the pieces of AlloGraft to help support the internal sutures.

Her previous implants were removed, and internal sutures were used to establish the “new” breast pocket.

AlloDerm was also used to improve the rippling by putting an extra layer of coverage between the implant and the skin due to the patient’s thin skin and minimal breast tissue.

The internal sutures create an “internal bra” to hold the new implants in it’s new position.

With the symmastia repair, improved appearance of her breasts by creating separation in her cleavage.

700cc silicone-filled breast implants were used in both breasts with submuscular placement.

Updated pictures will be soon posted, sent via e-mail by the patient.

Click here to see full details on this patient

Posted in AlloDerm, Breast Revision Surgery, Symmastia

This 25-year old patient from New York was very unhappy with her previous breast augmentation surgery in 2005, 2 revisionary breast surgery attempts in 2007 and again in 2008 (performed by another surgeon) to correct the mal-position of her implants.

The patient has the beginning stages of symmastia (implants merging together in the center of the chest), and excessive rippling. The patient found Dr. Pousti while searching for a Board Certified Reconstructive Surgeon on the Internet. The patient was impressed with Dr. Pousti’s experience with symmastia correction and decided to fly into San Diego for her 5^th revisionary breast surgery.

Dr. Pousti discussed her options with her and also discussed the internal suturing technique that would be used to correct the pocket position of the implants.

Markings were performed the night before surgery and details of her surgery was again disscussed.

The morning of surgery, Dr. Pousti re-measures and reinforce all makrings for the planned procedure.

Internal sutures were used to correct the symmastia and “bottoming out”, and “internal bra” was created to hole the implants in the “new” position. Alloderm was used in the cleavage area where the patient experienced rippling.

AlloDerm

After the symmastia and “bottoming out”, Dr. Pousti again measures and marks the appropriate areas where the AlloDerm would be placed.

Immediately after surgery.

The patient is now 14-months post-op surgery and is happy with her results.

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Posted in AlloDerm, Bottoming Out, Breast Asymmetry, Breast Revision Surgery, Symmastia

This 36-year old patient from Yuma, Arizona was interested in revision breast augmentation surgery. The patient previously had her breast augmentation surgery performed in 2000 by another surgeon, but due to capsular contraction and symmastia, the patient was unhappy with her previous surgery and looked into revisionary breast surgery.

She researched for a Board Certified Plastic Surgeon who is experienced in symmastia repair and found Dr. Pousti on the Internet. The patient drove from Arizona to San Diego, California to met with Dr. Pousti and decided to proceed with revisionary breast surgery.

The procedure of revision breast surgery (internal suturing to help with pocket correction and symmastia repair) were discussed with the patient.

Her previous implants were removed and internal suturing were perform to create an “internal bra” to improve the position of the implants without any additional scarring.

350cc silicone gel breast implants were used in both breasts with submuscular placement. Surgical tape also used to help protect the internal sutures and separation.

The patient is 6-months post-op surgery and very happy with her results.

Click here to see full details on this patient

Posted in Bottoming Out, Breast Revision Surgery, Symmastia