Breast Implant Revision Happens - But Symmastia Doesn't Have To
By Dr. Grant Stevens from About Plastic Surgery
Breast augmentation patients who experience symmastia or "bread loafing" must undergo breast implant revision to fix this problem. Picking the right plastic surgeon can help you avoid this complication in the first place.
Breast implant revision is a reality for most women who have augmentation mammaplasty. Implants manufactured today are more durable than older models, but expecting them to last a lifetime is unrealistic. However, the sad fact is that some women have to undergo more operations than necessary because of avoidable complications. Symmastia or "bread loafing" is one of these problems.
What is Symmastia and What Causes It?
When the connective tissue along the centerline of a patient's chest is compromised, the skin can pull away from the sternum. This distended skin gives breasts the appearance that they are a single unit taking up the entire width of the chest. Certain congenital chest wall deformities can cause this problem. However, the most common cause of symmastia is improper placement of breast implants.
During breast augmentation surgery, the plastic surgeon creates a pocket in the tissue on each side of the chest to hold the implants. When these pockets are positioned too close to the midline of the chest, this compromises the integrity of the tissue over the sternum. The connective may be cut or torn during the creation of the pocket or during the insertion of the implant.
Subglandular implants are associated with a higher risk of symmastia than implants placed under the muscle. In either case, this is a rare complication. However, when it does occur, it leads to serious malformation that can only be corrected by breast implant revision surgery.
Dispelling Myths about Symmastia
Large breast implants that are positioned correctly do not cause symmastia. However, a larger implant does require a larger pocket. This means implant size can be a contributing factor increasing the risk of symmastia when an inexperienced surgeon is performing the augmentation. A surgeon who is not properly trained is more likely to damage the connective tissues along the midline of a patient's chest while trying to accommodate a larger implant. Of course, breast implants of any size that are placed too close together in an attempt to create more cleavage (without taking underlying tissue structure into account) can end up with the "bread loaf" look.
Contrary to popular belief, being thin or small-framed does not increase your risk of symmastia. Going to an inexperienced surgeon does. Finding a board certified plastic surgeon with a well-established track record of inserting implants of all sizes correctly is your best bet for avoiding symmastia.
Don't Ignore Signs of Symmastia
Patients who experience symmastia as the result of unskilled surgical augmentation are sometimes told that what they perceive as bread loafing is simply swelling that will subside. Post-procedure swelling is a normal side effect; but it should not feel as if the skin has lifted away from your sternum. If you believe this is happening and your plastic surgeon dismisses your concerns, seek a second opinion.
Symmastia is a complication that a skilled surgeon knows how to avoid causing. This means it's probably not a good idea to have your original cosmetic surgeon try to fix symmastia. A botched repair may end up making the problem worse, leading to yet another round of breast implant revision surgery to repair the ensuing damage. Instead, focus on finding a plastic surgeon with the appropriate qualifications to perform your corrective procedure.
How Can Breast Implant Revision Surgery Fix This Problem?
If you have implants that were placed under the glandular tissue, these will need to be removed and placed under the pectoral muscle instead. If your implants are already submuscular, a plastic surgeon may use one of several methods to correct your symmastia. Some plastic surgeons use an older technique of repairing the existing pocket by patching or suturing it.
A more modern technique involves making a new pocket between the old pocket and the pectoral muscles. This approach relies on the strength of undamaged tissue surrounding the new pocket to prevent recurrence of symmastia rather than suturing damaged tissue in the old pocket. This newer approach to symmastia correction surgery is referred to as creating a "neosubpectoral pocket". Knowing this terminology can aid you in finding a plastic surgeon who uses the latest and most successful surgical techniques for symmastia repair.