Synmastia is a common issue. It is also spelled symmastia and often referred to in Boca Raton and other Florida cities as uni-boob. It occurs when breast implants are placed too close together creating too much cleavage. In extreme cases, there is a connection of the pockets with one implant going to the other side. The causes of this problem vary from patients anatomy to placement of too wide of an implant, to muscle tearing from trauma or most commonly from surgical error of too much medial dissection. This can happen with both above the muscle or below the muscle implants.
Correction of symmastia depends upon whether the original implants were placed over or under the pectoralis major muscle.
If the symmastia occurs with implants over the muscle correction involved converting the placement of the breast implants to.
For above the muscle implants that are too medial or have symmastia, conversion to below the muscle usually corrects the problem. This surgery involves removing the old implants and a portion of the breast capsule and elevating the pectoralis major muscle. The implant is placed under the muscle and a drain is placed. Sometimes Strattice (acellular dermal matrix) or Galaflex is used for extra support if the tissues are thin.
Correction of below the muscle implants with symmastia or that are too medial is more complex. There are two approaches that are very similar to the treatment of lateral displacement.
In this approach, the capsule is dissected free of the tissues towards the middle and the central tissues are closed in layers. The capsule is closed in an additional layer and Galaflex or Strattice ( acellular dermis) is used either just outside the capsule or inside the capsule for support. The implant (or new implant) is replaced and a drain may be placed if Strattice is used for a few days to a week. A special post-operative garment is used to place central pressure and prevent recurrence and may be used for up to 2 months or longer.
Before and after Strattice is placed inside to assist with correction.
In this approach, a new pocket is created between the outer capsule layer and the overlying muscle. The capsule has to be firm enough to use this approach. The implant is placed in this new pocket and Galaflex or Strattice may be used for additional support. A drain may be placed for a few days to a week if Strattice is used. A special post-operative garment is also used in this technique to place pressure over the central portion. This may be worn for up to two months or longer.
For a patient that has been operated on multiple times, we will occasionally use a combination of techniques and may use post-operatively adjustable saline implant to avoid placing tension on the repair. The saline implant is filled progressively after the tissues are healed. Garments and taping are similar to other approaches.
With all of the above techniques surgical and recovery times vary with degree of difficulty. Post operative taping and garments are essential to good outcomes. Timing of return to exercise varies as well and will be discussed individually at consultation.
Symmastia repair is done on an outpatient basis and you should arrange for someone to drive you home after your surgery and stay with you overnight. There will be some pain and swelling for a couple of days after surgery, and you will have prescription pain medication to help you stay comfortable in the early stages of healing. Soreness and swelling may last up to several weeks.
You will be seen the next day in the office and the surgical wrap removed. You will be placed in a soft bra (we provide). After you return you may shower and replace the bra provided. You will be seen a few days later for a follow-up to assess healing. You'll need to wear the bra provided until our staff says otherwise and avoid buying new bras until the swelling subsides, which may be a few weeks after surgery.
With all of the above techniques, surgical and recovery times vary with the degree of difficulty. Post-operative taping and garments are essential to good outcomes. Timing of return to work and exercise varies as well and will be discussed individually at consultation.
Here is a general timeline of breast lift recovery:
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