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Synmastia or Symmastia

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Synmastia in Boca Raton is a common issue.  It is also sometimes spelled symmastia and often referred to in Florida as uni-boob 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) 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 2 approaches that are very similar to treatment of lateral displacement on Boca Raton.

Capsulorraphy - 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 Strattice (pig 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 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 Strattice placed inside to help the

Neopectoral pocket - 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 Strattice may be used for additional support. A drain is placed for a few days to a week. A special post operative garment is also used in this technique to place pressure over the central portion. This may be worn up to 2 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.



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