Breast Augmentation - Pocket Perfection

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One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla). Dr. Pousti, at Pousti Plastic Surgery, has corrected these problems for many patients.

Symmastia (or medial mal-position or “uni-boob”) occurs when the breast implants move too far toward the midline–the two implants may actually 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 may result from overly aggressive attempts to alter chest wall anatomy trying to increase cleavage for 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. Correction involves use of internal sutures of the capsule around the breast implants. Often, it is necessary to expand the breast implant pocket laterally (outwardly) to allow for correct placement of the implants.

This 26-year-old patient from San Diego, CA. had her first breast augmentation in 2005. She noticed mal-position of her breast implants and came to Dr. Pousti for a consult regarding symmastia repair in 2007. Dr. Pousti performed reconstructive surgery in June of 2007. She is now post-op surgery with saline implants, filled to 330 cc on the left and 330 cc on the right made by the Inamed Corporation and pleased with her initial results.

This 23-year-old patient from San Diego, CA. had her first breast procedure in 2005. She noticed mal-position of her breast implants and came to Dr. Pousti for a consult regarding symmastia repair in 2007. Dr. Pousti performed reconstructive surgery and corrected her symmastia in March of 2007. She is now 6 months out of surgery and is very happy. She has 450cc saline implants.

Specific dressings and bra are used to reinforce the repair. 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.

Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. This is corrected by “raising” the inframammary fold using internal sutures. This is done after careful measurements are made from the areola to the “new” inframammary fold.

This 25 year old patient from Palm Desert, California had her first breast augmentation surgery performed in Mexico. A few months after getting her breast implants, she noticed that she had developed symmastia (the implants were touching down the mid-line) and her implants were bottoming out. She had a uni-boob (as some call it). The patient was extremely upset about the results and worried about having revisionary surgery. She found Dr. Pousti through her sister who had surgery and was very pleased with her results. She had bottoming out of both breast implants, encapsulation of both sides (left > right), and the areola were displaced laterally on both sides. This patient is ONLY 3 months out of surgery so there is still some bruising and swelling but we can see what an amazing result she achieved. This patient chose to have silicone gel implants (575cc on the left and 533cc on the right). She is VERY HAPPY with her results.

This 22 year old patient was not happy with the shape of her breasts after her first breast augmentation. The implants had bottomed out. She traveled from Boston, Massachusetts to have Dr. Pousti take care of her breast augmentation revision. She is very happy with her results. She has a 390cc saline implant on the left and a 370cc saline implant on the right.

This 23-year-old patient from Corona California had her first breast augmentation in 2005. She noticed her breast implants “bottoming out” and came to meet Dr. Pousti regarding corrective surgery of her breast implants in 2007. Dr. Pousti performed revisionary surgery with removal and replacement of both breast implants in May of 2007 with 390