Tom J. Pousti, MD - San Diego, CA Plastic Surgeon

www.poustiplasticsurgery.com

Symmastia Correction

Revisionary breast surgery is commonly performed at Pousti Plastic Surgery. For patients with malposition of the breast implants, it is very important that they have a qualified surgeon performing their revision. Medial displacement of breast implants is known as symmastia. This is commonly referred to as "breadloafing" or "uni-boob". This results from the loss of tissue support along the sternal area, allowing breast implants to move excessively towards the woman’s midline. If the pectoralis 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 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.

The degree of medial displacement varies from patient to patient and the reconstructive technique therefore, also varies. Usually, the medial displacement of the breast implants causes the nipple-areola complex to appear off-center on the patient’s breast mound. Often, there are other problems associated with the symmastia including “bottoming out” (inferior displacement of the breast implants), rippling / palpability of breast implants and breast asymmetry.

Correction of symmastia involves careful planning and intra-operative reinforcement of the medial fold of the breasts. Reconstruction usually involves removal of the breast implants and internal suture reinforcement of the involved area. The use of dyes and needles through the skin surface assists the exact placement of permanent sutures. Usually the breast implant capsule that is redundant is removed to allow for two raw surfaces to heal together, presumably lowering the rate of recurrence of the symmastia. Often, it is necessary to “open” 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. Use of a smaller breast implant, if possible, may serve the same purpose.

For correction of symmastia, the procedure can take from 2-3 hours depending on how much work is involved. Board Certified Plastic Surgeon, Dr. Pousti takes his time in the operating room to make sure that he does what he can to achieve the best result for the patient.

An incision is made (usually under the areola) to expose the underlying tissue, muscle, and implant.

The tissue that surrounds the implant is removed in the area of the planned repair.

Tissue is sutured together to hold implant in place (with permanent sutures).

The incision is then sutured close.

Intra-operatively, sitting the patient upright is imperative to assess the repair and degree of symmetry. Patience is important as multiple trials of suturing may be necessary to achieve satisfactory repair and symmetry.

Post-operatively, the use of tape is used to apply pressure on the previously elevated skin overlying the sternum. Compressive dressings and a pressure bra are also helpful.

What To Expect After Surgery

Bed rest, along with plenty of fluids, is necessary after surgery. Your chest will be sore. Pousti will prescribe appropriate pain management medications. Take your medication regularly and keep your office visits. Usually after a week, you will begin to feel back to normal.

A brassiere and bandeau will be fitted for you during your first week of recovery. These will need to be worn for a month. You will not be able to shower until your sutures are removed. Initially, breast implants will appear to be slightly higher than normal and your breasts will be swollen. Over time, the breast implants will descend to a more natural position.

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.

Testimonial #1:

I had suffered from symmastia after I had my first breast augmentation done by a plastic surgeon in Florida. I was happy to learn that Dr. Pousti had experience with symmastia correction and was 100% certain that he was the one I wanted to fix my problem. Dr. Pousti has been great from the moment my husband and I met him. He has been very kind and he informed us in great detail about the procedure. Now, 5 weeks after my operation, I would not be any happier with the results. Not only is the symmastia corrected, but Dr. Pousti was also able to consider my wishes regarding the size and look of my breasts. Dr. Pousti is a great surgeon and I am convinced that everyone who suffers from symmastia cannot find a more qualified and experienced surgeon in the U.S. to correct this problem. I am very thankful to Dr. Pousti and his outstanding staff!!

Testimonial #2:

I had my first breast augmentation surgery a little over 2 years ago from another doctor. I knew something was wrong as soon as the bandages were removed. I will never forget that day, I cried the second I saw my new breasts- that didn’t look like breasts at all. My doctor (at the time) told me that it was because my scar tissue had become too tight and it was pushing my breasts towards each other. He suggested a second surgery in which he would fix the problem. Needless to say the second surgery did absolutely nothing to fix the problem; it was nothing but an unnecessary surgery. I knew that something was out of wack, and began to do my own research. I found out about symmastia and knew that it was what I had. I gave my doctor the benefit of the doubt and went back to him one more time. He basically told me that this is just how my body is, and I was going to have to deal. He told me he would perform the same surgery again (if it didn’t help the first time why would it help the second time!!!)

That’s when I began my search for a doctor to fix me! I got extremely lucky and came across Dr. Pousti’s web page while doing further research about symmastia. He is the only doctor in the area I found that specializes in the procedure (and I only saw a few others in the whole country). I made an appointment right away.

I came in for my consult and was blown away by the difference in treatment I received from the very start. The waiting room has a spa feel to it. The girls that work in the office are all amazing and take wonderful care of us patients. Dr. Pousti sat and talked with me longer than my other doctor saw me the whole time I was his patient. He made me feel comfortable, and although it was hard to trust another doctor, Dr. Pousti gained my trust right away. I was told from the beginning that if he felt he couldn’t fix me that he would tell me. Luckily he said I had a great chance of being fixed. Although it wasn’t 100% there is no one else I would have trusted to do a better job.

The difference this surgery has made on my body is amazing. After my first breast augmentation I gained some weight because I was so depressed. I looked even worse because of the way my breasts were placed- almost like a tree trunk. Now, although I still have a little bit of extra weight on me I look curvy- and feel amazing. Thank you so much Dr. Pousti for making me feel like the woman I wanted to feel like over two years ago when I first decided to have this done. The results are amazing, and I would recommend you to all of my friends, family, anyone. And thanks to the girls in the office for making this whole process much more enjoyable than surgery normally would be. I plan on coming back to Dr. Pousti if I ever need anything else done.