One of the more common problems that patients are seeking Dr. Pousti’s help for is symmastia. 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, 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.
Some patients present with Congenital Symmastia (a condition they are born with).
Before & After Symmastia Correction
markings are performed prior to surgery
Since Dr. Pousti has experience with symmastia repair, many women from around the country choose to fly to La Jolla or San Diego to obtain his services. If you are not from the La Jolla / San Diego area, please visit Fly in for Surgery to learn more about our out-of-town accommodations and scheduling information.
The Surgical Procedure
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. The repair of symmastia requires additional surgery to move the implant back into the pocket of original placement. All sutures are internal – there are no new scars placed on the breasts.
- The tissue that encapsulates the implant is cut and rolled back to fit into the pocket.
- Tissue is sutured together to hold implant in place.
- The muscle is then sutured internally back in place, connecting the sternum.
- The incision is then sutured close.
Prior to Surgery
After Symmastia Repair
During your consultation at our San Diego office and after a thorough examination, Dr. Pousti will discuss every detail of your breast augmentation, including the exact size and type of breast implants he will use and their relative advantages. This procedure to correct symmastia is performed on an outpatient basis at our surgical center in San Diego under general anesthesia.
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.
Patient Emailed Pictures 7 months post op Symmastia Repair
Resumption Of Physical Activities
Driving may be resumed in 1-2 weeks.
Non-contact sports in 3 weeks.
Contact sports and lifting heavy objects in 6 weeks.
Doctor’s Notes on Procedure
One of the more common problems that patients seek correction for is symmastia. Symmastia – commonly referred to as “bread-loafing” or “uni-boob”- occurs when two implants touch one another in the center of the chest and can be seen anywhere from several days to several months after the original breast augmentation surgery. The causes of this condition vary from patient anatomy, incorrect implant width for the patient, and overly aggressive attempts to alter chest wall anatomy while trying to increase cleavage. The implant can move toward the middle of the chest with aggressive pocket dissection and/or if the pectoralis major muscle is cut during surgery. This problem can be seen in both sub-glandular and sub-muscular implant positioning.
Symmastia is more prevalent in certain sup-groups of the population. Thin women experience this problem more commonly than others, most likely due to their limited body fat and tissue covering the sternum. Also, women with pectus excavatum have an increased chance of developing symmastia. The down-sloping of the breastbone in this condition allows the implants to slide inwards, causing an increase in pressure on the local tissues. Using smaller implants in more susceptible patients can help prevent this problem.
The repair of symmastia requires additional surgery where the original implants are removed, internal sutures are added, and new implants are placed if possible. Of note, this procedure used entirely internal sutures to avoid additional scarring on the breasts. These sutures are permanent and are placed within the capsule that is currently around the breast implant. In some cases, smaller implants are used in order to avoid excessive pressure on the internal sutures.
Prior to surgery, the patient is marked to outline where the internal sutures will be placed This internal bra will place the breast implants in the correct position on the chest wall — separating the 2 implants.
(Intra-Operative) Internal sutures were used to create an “internal bra” for the new positions of the implants. There is now a distinct separation of the two breasts.
The incisions are closed, and a surgical bra and dressings are applied in the operating room. After surgery, the patient is required to wear a “thong bra” and surgical tape for approximately three months to help the tissues re-adhere to their proper places.
I’ve been dealing with Symmastia since my first breast job in 06. Then in 08 I went to go get my breast fixed from symmastia and rippling. The doctor made it worst and just larger. I wanted larger but not closer together. I found Dr Pousti online. Saw he deals with these issues all the time. Excited to not have these issues. I am wanting perky and 2 finger space gap between my breast, fullness on top and straight. The 3rd time I’m hoping it’ll be great. Fingers crossed. Dr. Pousti already knows I’m hoping for the best so I know he will do the best he can. It’s just sad after all the money and recovery I’ve been Through already with 2 breast jobs, some doctors just do not know what they r doin. I’ve done extensive research. And I have been to 4 consultations. I picked Dr. Pousti because he specializes in symmastia and larger breasted women. I’ll post results soon. I think Doctor Pousti knows what I need done. He listened to my whole list of questions. I’m praying for best results and speedy recovery.
Dr. Pousti has given me the best gift I’ve ever received – my confidence back. Four years ago when I was only 18, I had breast augmentation performed by another local plastic surgeon, Dr. Kincaid. Being so young and eager, I blew off the obvious warning signs that he was not a good surgeon and chose him anyway. Though I stated time and time again that I wanted a natural, realistic looking chest for my size, I ended up with breasts that were anything but natural looking. I knew right away that he had left me with symmastia, and despite trying everything I could think of to get them to separate, they would not move. This was devastating to me as it meant I had spent all that money to end up worse off than I was before. Instead of gaining confidence, I gained embarrassment and physical pain. I couldn’t wear anything low-cut and hated trying to find bathing suits that would cover up the center of my chest. I spent the next four years hiding behind bulky clothes so that no one would know the awful thing I was hiding. I even tried my best to keep them from my longtime boyfriend, who I had started dating before I ever had implants.
By the time I turned 22 I knew I had to do something about them. I started researching different techniques to fix symmastia online and found that most of the before and after photos I was seeing on various websites were all attributed to Dr. Pousti. When I saw the great reviews people had left for him, I knew I wanted a consultation.
The difference between Dr. Pousti’s office and the office of my prior surgeon is like day and night. The girls at the front desk are all very nice and helpful, and Dr. Pousti is always on time for appointments. From our first meeting I knew that I wanted him to be the one to fix my symmastia. I think I visited his office three times in five days early on because I had so many questions and concerns regarding my procedure. Even though I had emailed him my questions, he invited me in to his office versus emailing me back to make sure I got a clear answer I could be satisfied with. Dr. Pousti’s confidence in his ability to fix my symmastia gave me confidence too. He was even able to schedule my surgery with very short notice, since it would be the only time my work and school schedule would allow for two weeks off until the following year. It’s amazing to me how he went out of his way time and time again to help me during the whole process.
The day of my surgery I was surprising calm. Aside from a little nervousness about how much pain I would be in after surgery, I wasn’t nervous at all about the procedure going well – I just knew it would. Most people thought I’d be a nervous wreck, seeing as how my last surgery ended up so horribly, but my faith in Dr. Pousti’s ability was quite strong. He just has this way about him that’s very reassuring and calming.
The surgical facility was also excellent. The nurses there were very kind and understanding, and did their best to make me feel comfortable. Right before I went under, I had both a nurse and Dr. Pousti holding my hands as the anesthesia went in, telling me not to worry. When I woke up, aside from the pain and grogginess that is to be expected, I felt great.
Interestingly, my pain after my symmastia revision surgery was far less than the pain I experienced after my initial augmentation. The day of my surgery I went home and was climbing stairs and watching TV, and the day after I went out to eat. In fact, the hardest part of my initial recovery was resisting the temptation to take off my tape/bandages to see what my new breasts looked like, but I figured if I could wait four years, I could wait a few more weeks.
When I was finally able to view the results of my surgery, I was absolutely amazed. Before where my breasts had touched and puffed up now laid a smooth, flat area of skin. The size of the space was perfect, and even though I was still somewhat swollen, I knew Dr. Pousti had listened to my wishes that I not have too much fullness on top. Seeing my results literally brought tears of happiness to my eyes, they were that great.
Now, about three months post-op, my breasts are softer, rounder, and more natural looking than ever. I have been wearing my “thong” bra religiously, and have resisted the urge to wear a normal bra or exercise. I was having a little trouble massaging the implants as often as Dr. Pousti told me to at first, so to ensure they stayed soft he put me on an anti-inflammatory medicine that has been helping tremendously. Also, the space between my implants is still flat and smooth, with no tenting or rippling to speak of.
I can now wear any type of top or bathing suit I like, and my breasts look great. I recently went bra shopping and for the first time, it was a pleasant experience. My life is becoming more in line with how normal 22 year olds live – I’m going out more and have more confidence, and I am no longer put in awkward situations where my old breasts would have held me back. This operation was truly life changing, and I cannot say enough about the amazing job Dr. Pousti and his staff have done for me.
If there’s one thought I want to leave people with, it’s that selecting the right surgeon is the most important decision you’ll ever make. Dr. Pousti is so talented at what he does, and shows genuine concern and compassion for his patients like I have not seen with any other doctor. His ability to fix what most other surgeons told me was difficult if not impossible to do shows what a true professional he really is. I only wish I had met him four years ago, but I’m more grateful than anyone can know to have him as my surgeon for my revision. Thank you Dr. Pousti and your wonderful staff for changing my life for the better.
I lived with symmastia for 9 years and lots of discomfort and some pain through out the years. i had my first breast augmentation done in Mexico. Through out the years I have been very unhappy with the look of my breast. I was embarrassed to wear a bikini or any low cut shirts. When I was doing some research on symmastia I came across with Dr. Pousti web site I became very excited to be able to find a Dr. that provide before and after pictures of symmastia I had always thought it was just me with this problem. when I went through the pictures I just wanted to cry of excitement because there is a Dr. that is able to fix that kind of problems. when I first talk to Dr. Pousti’s staff over the phone they were very friendly. Since I live in Arizona they worked with me through the phone and emails. They where able to work out a date that was fitting for me for my consultation and pre-op appointment that’s when I first meet Dr. Pousti and his staff. Daisy, Vanessa and staff really made me feel welcome and like we knew each other for many years it was great. When I meet Dr. Pousti he took a look at me and told me that he was able to fix my symmastia and would be very happy with the results. He reassured me that he was able to fix it that there wouldn’t be a problem and that not to worry. That was the greatest feeling ever I felt lost of comfort and I was very sure that I had picked the correct Dr. for my problem.After my surgery Dr. Pousti and Staff was in contact with me to check how things was going.It made and makes me feel like I wasn’t just A dollar bill to them they really do care.It’s been one month since my surgery and everything is going great I am extremely satisfy with the results. I can’t believe how much of a difference there is from before and after i honestly can’t stay away from the mirrors it is just so amazing Dr. Pousti went all out he did a wonderful job I have been recommend him to everyone he is the right Dr. to go to I just wish that I knew about him a lot sooner. I will always continue to recommend Dr. Pousti to all my friends that are considering on getting any work done. He is a great Dr.. Thank you very much Dr. Pousti you are a wonderful doctor and you have a great staff!