This 27 year old patient from Ohio had been in communication with Dr. Pousti’s office regarding her interest in revisionary breast surgery and specifically correction of her symmastia. The patient had her original breast augmentation performed in 2006 and symmastia correction in 2008 with a previous surgeon. She was left unhappy with her results and decided to do more research to find a qualified surgeon with experience in breast revision surgery.

Symmastia occurs when the muscle between the implants lifts from the sternum causing a ‘breadloafing’ or ‘uniboob’ look.

Prior to the procedure the patient is examined by Dr. Pousti who then takes measurements and does the markings. Markings along with the entire symmastia repair procedure are reviewed with the patient in detail.

The red markings between the breast indicate where the symmastia is present and where correction must take place. To correct symmastia Dr. Pousti sutures the muscle back to the sternum internally.

In some cases, like this patient, the pectoral muscle is very damaged and allograft is needed to help cover the implant.

Symmastia correction can take anywhere from 2-3 hours depending on the complexity of the case.

Patients are asked to bring in pictures of their desired goals which are used in the operating room in conjunction with sizers to determine the size of the implant needed.

Before/After Symmastia Correction

This patient is post op removal of old breast implants, correction of symmastia with the use of internal suturing and allograft and re-augmentation with silicone gel implants.

This 41 year old patient from Price, Utah had 2 breast procedures performed previously by another surgeon and was still unhappy with her results. The patient didn’t feel comfortable returning to her previous surgeon and decided to do more research to find a Plastic surgeon with expertise in revisionary breast surgery. While doing research online she came across board certified plastic surgeon Dr. Pousti and was impressed with his revisionary breast surgery experience.

During the examination it was apparent that the patient had breast implant malposition and symmastia. Symmastia, commonly referred to as ‘uni-boob’ or ‘tenting’, occurs when the implants touch in the center of the chest. In order for symmastia correction to take place internal suturing must be done.

Before symmastia repair can be done the patient’s current breast implants are removed. Dr. Pousti generally uses the same incision sites to prevent additional scars.

Dr. Pousti uses internal suture to re-attach the muscle vertically to the sternum. Before the actual sutures are used markings are made to indicate where they must be.  It was discussed in detail that “skin tenting” is difficult to correct and sometimes when the breast implant mal-position is corrected, the “tenting” may remain.

The patient had her breast lift revised, re-augmentation with silicone gel implants, areolar reduction and correction of symmastia.

She is very happy with her initial breast procedure results.

This 30 year old from Apple Valley, California was interested in revisionary breast surgery. She was unsatisfied with her results from her previous surgeon. She did not like the shape, size, or placement of her breast implants and she also suffered from implant malposition resulting in symmastia. She researched the internet for experienced breast revision surgeons and found Dr. Tom Pousti. After reviewing many symmastia and breast revision repair cases, she felt optimistic that he would be able to achieve the same results with her and decided to drive to see Dr. Pousti.

Upon examination, Dr. Pousti determined the patient not only had symmastia, but “bottoming out” of her implants as well. Symmastia appears when two implants are touching one another often creating a “uni-boob”. Symmastia often happens if the horizontal muscle that is connected to the sternum is cut during surgery and after overly aggressive attempts to achieve cleavage are made.

The patient and Dr. Pousti met again to discuss the procedure in detail along with recovery. Markings were done the night prior to surgery and were reinforced the morning of surgery. In order to achieve her desired look, internal sutures were used to repair her cleavage area and to also create an “internal bra” for the new position of the implants and to fix the bottoming out of the implants.

Dr. Pousti removed the patient’s previous implants through a small incision of the areola.

Immediately After Symmastia and Bottoming Out Repair

He replaced the patient’s previous implants with 475cc Silicone Gel Breast Implants. After repairs were made, the patient has two distinct breast pockets.

Bolster dressings are worn for several weeks to protect the repaired area during recovery.

The patient is very happy with her results.

This 22 year old patient from San Diego, California had breast augmentation surgery performed by a previous surgeon and was left with unsatisfactory results. The patient was not happy with the overall appearance of her breasts but the breast shape bothered her the most. She did not feel comfortable returning to her previous surgeon and knew that she would have to do research to find a surgeon that was experienced with revisionary breast surgery. During her search she came across Dr. Pousti several times and was very impressed with the vast amount of experience he had with breast revision procedures.

Upon examination it was apparent to Dr. Pousti that the patient had a severe case of ‘Symmastia’. Symmastia occurs when the skin near the cleavage area separates from the sternum; causing the implants to be malpositioned medially. This can cause the breasts to form a ‘bread-loaf‘ appearance.

The patient and Dr. Pousti meet several times prior to the revisionary breast surgery to discuss options and go over the procedure in detail. In this patient’s case the best option was to go with symmastia repair and an implant exchange. The first step of this surgery is to take measurements of the patients chest and mark the areas where correction is needed.

When the patient is in the operating room she is placed in an upright position and markings are re-checked. If any adjustments are needed they are done at this time. The red area indicates where the symmastia repair will need to be done.

The patient’s current breast implants are taken out through a small incision along the areola. To avoid additional scaring the previous incisions were re-used. Once the implants are removed Dr. Pousti begins work on the ‘breast pocket’. A breast pocket is an open pocket created under the muscle where the breast implants sits.

During symmastia repair Dr. Pousti uses internal sutures to re-attach the skin to the sternum in the center of the patient’s chest. Sizers are then used to determine the size of the implant Dr. Pousti will need to use in order to achieve the patient’s desired look.

300cc Silicone Gel Implants were used in both breast to meet her goals.

As you can see when the patient is in a lying down position the symmastia correction has improved the appearance of the chest and the patient no longer has ‘tenting‘ present.

After the procedure is completed, bolster dressings are applied. The dressings help add support to the internal sutures and help ensure that implant malplacement does not reoccur.

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A “thong bra” is then given to patient to wear post surgery and 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.

This  29 year old from San Antonio, Texas was interested in breast revision surgery to correct the symmastia present after her previous breast augmentation. She felt extremely uncomfortable with her “uni-boob” and after two failed breast surgeries, she decided to research for a qualified surgeon to perform her revision surgery. She began researching online and found double board certified plastic and reconstructive surgeon, Dr. Tom Pousti. She reviewed several “before” and “after” pictures of symmastia repairs performed by Dr. Pousti and was extremely impressed.

After exchanging several emails and telephone calls, the patient decided to fly to California to have her breast revision surgery performed. Upon the patient’s arrival, Dr. Pousti examined the patient and determined that capsulorrhaphy, an implant exchange, and the use of allograft was needed to repair the patient’s current symmastia.

Dr. Pousti and the patient met in the pre-operative area prior to surgery to take measurements and perform markings. These markings are used as a guideline during surgery to try to achieve as much symmetry as possible and to determine where internal sutures will be placed.

The green shaded area indicates where pocket repair will be done to improve implant placement.

An incision around the areola was used to remove the placements previous implants. The patient and Dr. Pousti discussed having an incision almost around the entire areola to remove the patient’s scar from her previous breast augmentation in hopes that her new scar will be less noticeable.

In some breast revision cases, allograft is needed to help with coverage of the implant. Alloderm or allograft is made from donated human skin, but is processed to remove cells, so that a collagen structure is left over for the skin to grow on and around.

Once the allograft is securely placed, Dr. Pousti begins the capsulorrhaphy. Capsulorrhaphy, commonly known as internal sutures, was performed to repair the breast pocket. These permanent internal sutures close off a portion of the breast pocket to improve implant placement. The internal bra is permanent and was used to repair the patients severe symmastia. Symmastia or breed-loafing occurs when two implants touch one another in the middle of the chest. Symmastia is caused by a muscle being cut during surgery from overly aggressive attempts to achieve cleavage.

When the internal repairs were completed, Dr. Pousti used implant sizers to determine implant sizing. The sizer implants are filled with air until the patient’s desired breast size has been achieved. Once sizing is determined, the sizer implants are removed and the final implants are prepped for placement. Dr. Pousti used a 250cc silicone gel implant on the right breast and a 235cc implant on the left breast.

Before/After Breast Revision Surgery

This 30 year old patient from Northern California was interested in breast revision surgery for several years after being left unsatisfied with her two previous breast augmentation surgeries performed by another surgeon. She was unhappy with the shape and placement of her breast implants and felt uncomfortable with the “uni-boob” appearance she had developed after her previous surgeries. She researched online for a board certified plastic surgeon and was impressed when she found double board certified plastic and reconstructive surgeon Dr. Pousti. She decided to fly to Southern California to meet with Dr. Pousti and discuss her options.

Dr. Pousti examined the patient and determined she had a mild case of symmastia often referred to as “uni-boob” or “breed-loafing“. Symmastia occurs when the breast implant pocket is over-dissected during surgery after overly aggressive attempts to achieve cleavage. Capsulorrhaphy is used to improve the placement of the implants and correct symmastia. During her visit, she was able to meet with some of Dr. Pousti’s previous breast revision patients to hear about their experience and see their results in person. After her consultation, she felt extrememly confident in Dr. Pousti’s ability to achieve her goals and decided to proceed with her surgery.

The patient flew into Southern California the day prior to surgery to meet with Dr. Pousti again and perform markings. The arrows represent where the patient would like to achieve more fullness. The red shaded area illustrates the location for the internal sutures that must be used to repair the breast pocket to prevent the implants from migrating towards the center of the chest.

Before Breast Revision

Once markings are completed a small incision is made along the areola and the patient’s previous breast implants are removed. Dr. Pousti then carefully reattaches the muscle to the chest wall using internal sutures.

The patient’s previous 500cc Silicone implants are sterilized and placed back into the patient’s breast pocket.

After Breast Revision

Before / After Breast Revision

The patient is very pleased with the results of her revisionary breast surgery with symmastia correction.

This 42 year old female from Placentia, California was unhappy with the results of her breast surgeries performed by her previous surgeon. She previously had a breast augmentation surgery and two breast revision surgeries and was left unsatisfied with her breast. After being left unhappy with her previous choices in surgeons, she decided to research for an experienced plastic surgeon. She found Dr. Pousti online and was impressed with his experience with breast revision procedures.

After examination, Dr. Pousti determined the patient had developed mild symmastia. Symmastia, commonly referred to as “breed-loafing” or “uni-boob”, occurs when the breast pocket is over dissected in an attempt to achieve cleavage. To correct symmastia and achieve better symmetry, Dr. Pousti recommended capsulorrhaphy and and implant exchange. During her consultation, she was able to meet with Dr. Pousti’s previous breast revision patient’s to discuss their journey before, during, after surgery.

Prior to the start of surgery, Dr. Pousti performed markings that are used as a guide throughout the surgery. The red shaded area indicates where capsulorrhaphy is performed to repair symmastia and the arrows represent where the patient would like to achieve more fullness.

The patient was uncomfortable with the raised skin in the middle of her chest, also known as skin tinting.

Through a small incision on the areola, the patient’s previous implants were removed. Dr. Pousti is then able to begin capsulorrhaphy to repair the breast pocket. Internal sutures were used medially to close off the breast pockets to prevent the implants from migrating towards the center of her chest. After the first layer of internal sutures, sizer implants are used to determine implant sizing. The patient is sat upright to preview potential results and the second layer of internal sutures are applied.

Dr. Pousti removed the patient’s previous implants, performed capsulorrhaphy, and re-augmented the breasts using a 810cc saline implant on the right breast and 840cc saline implant on the left breast.

Bolster dressings are worn in the center of the chest to apply pressure to the repaired area.

The patient is extremely happy with the results of her breast augmentation surgery.

This 21 year old female presented with  congenital symmastia and was interested in breast augmentation surgery and correction of the symmastia. She wanted to achieve defined cleavage with some fullness on top. She was referred to Dr. Pousti by a friend of hers and previous patient of his and was very impressed with his credentials and years of experience with complicated breast surgeries.

Dr. Pousti and the patient met prior to surgery to perform markings and discuss the planned procedure.

The shaded red area represents the elevated skin in her cleavage section causing congenital symmastia.

Congenital symmastia is when a patient does not have adherence of skin to the sternum and no defined cleavage.

The planned procedure was to reduce the soft tissues over the sternum and to cause inflammation of the tissue to promote adherence of the skin to the sternal area.

Liposuction of the soft tissues in the sternal area was performed.

Sizer implants were used in the operating room to determine final implant size. The sizer implant was filled with air until the patient’s desired breast size was achieved. The patient was sat upright several times to view potential results.

To promote symmetry, a 420cc saline filled implant was used on her right breast and a 390cc saline implant was used on her left breast.

Pressure tapes/dressings were applied and are worn for several weeks after surgery.

Patient Testimonial:

I had a life changing experiance with Dr. P and his staff. They did such a great with me. I’m not even all the way through with my recovery and I already feel more confident and honestly like a new woman.

I had natural symastia and after having my son it just seemed to worsen also my breast were two different sizes. I did not feel comfortable in my body and it was so stressful trying to find bras and clothes that fit me right.
Over the last year in a half I went and spoke to so many Dr’s in southern Cali and not one knew how to go about what I wanted fixed. They had either never done the procedure or had an odd way of going about fixing the symmastia.

Until a friend recommended Dr. Pousti. He is a great person. He listens. He cares. He understands. He is respectful. He knew right away what I wanted what I needed and the best way to do it. I remember coming home from my first office visit with him and I was so happy and excited that I finally found the right doctor and with out a doubt the best doctor for me. He did everything I wanted and more. Dr. P and his staff changed my life and I couldn’t thank them enough.

This 34 year old female had previously had breast augmentation surgery performed by another surgeon in Northern San Diego Area.  She started off with slight tuberous breasts but after her first surgery, she was not happy with her results and was interested in correction of her implant mal position (bottoming out and symmastia).    She had lost sensation on her right breast and was also experiencing pain on that side.

The implants had “bottomed out” and were also too close together in the cleavage area (symmastia). She researched for a Board Certified Plastic Surgeon with experience in Breast Augmentation Revision Surgery and found Dr. Pousti.

After meeting the patient and examining her, Dr. Pousti stated that she was a good candidate for Revision Breast Surgery.  He recommended capsulorrhaphy (internal bra) medially as well as on the lower part of her breasts.  Dr. Pousti uses 2 layers of permanent sutures for the breast pocket correction and asks patients to watch the arm movement and heavy lifting after surgery to ensure that the repair is successful.

Markings are performed and measurements are taken the night prior to surgery.  Dr. Pousti plans his surgery and discusses everything with the patient in detail.  The red arrows indicate where the patient wants “more fullness” and the red shaded area in the middle indicates where the permanent sutures will be placed to correct the medial implant map-position.

Below shows the patient in the operating room
Before surgery — Immediately after Breast Revision Surgery

She had bilateral breast implant removal, bilateral capsulorrhaphy and re- augmentation with new silicone gel breast implants.

This 28-year old patient from San Diego, California was interested in revision breast surgery, the patient previously had breast augmentation surgery (performed by another surgeon) and wanted to improve the placement on her breast implants.

Due to “bottoming out” (inferior migration of the implants) and “symmastia” (occurs when two implants meet one another in the center of the chest) the patient was unhappy with the results of her previous surgery.  The patient researched for the most experienced Board Certified Plastic and Reconstructive Surgeon to perform her revisionary breast surgery and found Dr. Pousti. After  looking through before and after pictures of countless patients with the same complications, she felt that she had found the best plastic surgeon for her breast augmentation revision surgery.

Markings were carefully drawn out in detail prior to surgery.  Measurements were made and all efforts will be made to achieve the patients goals.

Measurements are re-checked again in the operating room.

Above, you will see the “shaded area” where internal sutures (capsulorrhaphy) will be performed for breast implant pocket correction.

Intra-operative photos above show the breast implants removed and internal sutures used to create an “internal bra” to correct the implant mal-postion and symmastia. Liposuction of the chest (cleavage area) was also performed at this time.

(Intra-operative) Round, moderate plus profile 470cc silicone-gel breast implants were used in both breasts.

This 41 year old patient from Arizona had breast augmentation surgery in 1992 and again in 2002 by a previous surgeon in her home town. The patient developed symmastia, also know as ‘bread loafing’. Symmastia occurs when two implants touch one another in the center of the chest. 8 years later she decided to proceed with revisionary breast surgery to correct her symmastia and to add volume to her breasts. The patient found Dr. Pousti online and ultimately decided he was worth the travel to San Diego, California due to his experience with breast reconstruction surgery.

The patient met with Dr. Pousti and his staff the day before surgery in his office. The entire breast revision procedure was reviewed in detail with the patient and markings were made.

The red arrows indicate where the patient desires more fullness and the red portion that is colored in the middle is where the symmastia repair will take place.

Once the patient is in the operating room she is placed in an upright position and her measurements and markings are re-checked.

After implants are removed the symmastia repair portion of the surgery is performed. In order to correct this patient’s implant malposition Dr. Pousti used internal sutures to re-attach the muscle back to the sternum. This is also knows as ‘pocket correction’. Once symmastia repair is completed sizers are used to determine the size of implant needed to achieve the patient’s size goals. To achieve this patient’s desired look a 800cc Saline implant overfilled to 920 was used in her right breast and a 800cc saline implant overfilled to 820 was used in her left.

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. This is more noticeable when the patient is in the prone (laying down) position.

Before

Immediately After Surgery

Bolster dressing is placed immediately after and is to be worn along with a ‘thong bra’ for 1 month to stabilize the area and help prevent symmastia occurrence.

The patient is extremely pleased with her initial results.

This 32 year-old patient traveled from out of the country to have Dr. Pousti preform breast revisionary surgery.  The patient previously had breast augmentation surgery as well as two revisionary surgeries, all preformed by other plastic surgeons.  Due to breast asymmetry and symmastia the patient was unhappy with the results of her surgeries. 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.

The patient researched for the most experienced Board Certified Plastic and Reconstructive Surgeon to perform her revisionary breast surgery and found Dr. Pousti. After reading outstanding reviews and looking through before and after pictures of countless patients with the same complications, she knew she had found the best plastic surgeon for her breast augmentation revision surgery. Immediately after several consultations via e-mail, phone and office, the patient scheduled for surgery.

Dr. Pousti takes his time measuring things out and marking on the patient to prepare for surgery.

The risk and potential complications were reviewed and discussed with the patient in detail the prior to surgery.

Dr. Pousti has experience in breast revisionary surgery and knew exactly what  needed to be done to achieve the patient’s goals.  It was decided that medially capsulorrhaphy (internal sutures) would be performed for better breast implant placement on the chest wall along with the use of allograft.

Due to very little breast tissue and thin skin, her old breast implants were removed and Alloderm (Dermis) was inserted medially for  more support (the green drawings).

immediately after implant removal and after the internal sutures are preformed with use of allograft

Below, you can see that the temporary sizers that are placed  before re-augmentation to check for size and symmetry

before and immediately after breast revisionary surgery with capsulorrhaphy and allograft

The old breast implants were removed and replaced with 457cc silicone gel implants to achieve the patients desired look.

The patient before and 3 1/2 months after surgery

This 42 year-old patient from El Cajon, California was interested in breast augmentation revision surgery, the patient was post breast augmentation surgery and 2 breast revisionary surgeries (all performed by another surgeon).  Unhappy with her breasts shape and mal positioning she wanted breast revision surgery to correct it.

The patient researched for an experienced Board Certified Plastic and Reconstructive Surgeon to help her with her complex case. After looking through numerous successful breast revision surgery performed by Dr. Pousti, the patient knew Dr. Pousti was the best plastic surgeon for her.

Dr. Pousti has experience in breast augmentation revision surgery and knew exactly what  needed to be done to achieve the patient’s goals.  It was decided that capsulorrhaphy (internal sutures) would be performed with 2 layers of permanent sutures for better breast implant placement on the chest wall.

Markings and measurements are preformed prior to surgery – the arrows indicate where the patient wants more fullness.

The red lines indicate where the internal sutures will be placed to separate the breast implants.

The red arrows indicate more lateral fullness on the right side.

Immediately after the old implants are removed and bilateral capsulorrhaphy (medial & inferior) was preformed

Below, you can see that the temporary sizers that are placed  before re-augmentation to check for size and symmetry

before and immediately after breast revisionary surgery

immediately after breast revision surgery (side view)

550cc silicone gel implants were used along with capsulorrhaphy.  The bolster dressing is placed for support where the repair was performed.

This 25 year old patient from Orange County was interested in breast augmentation revision surgery to correct her 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 submuscular implant placement allows the muscle to provide some softening of the transition to the cleavage area from the augmented breast mound.

The patient researched for an experienced Board Certified Plastic and Reconstructive Surgeon to help her with her complex case and found double board certified plastic surgeon, Dr. Pousti.  She drove down from Irvine to meet with Dr. Pousti and to discuss her options.

Dr. Pousti discussed capsulorrhaphy surgery to correct the implant mal-position as well as the use of AlloGraft.  The risk and complications were reviewed and markings were made in detail.

The green areas above show where the internal sutures will be placed for better implant positioning.  The black outline is where the AlloDerm is placed.  The patient has bilateral 495cc silicone gel breast implants.

The tape is used to reinforce the separation of the breasts and help support the repaired area.

This 24 year old healthy female from Costa Mesa, California had previously had breast augmentation surgery with 350cc breast implants (performed by another surgeon). The patient presented with significant breast implant mal-position medially and inferiorly (the breast implants were displaced too low and too far toward the cleavage area), therefore causing the nipple-areolar complexes to be off centered and pointing outward.

She was unhappy with her results and desired her breast image to be corrected. She began a google search for a board certified plastic surgeon who had experience in symmastia repair and came across Dr. Pousti. 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.

She scheduled a consultation and had the opportunity to speak with Dr. Pousti regarding the options to correct her implant displacement along with the possible risks and complications associated with any surgery. For this patients specific case, she and Dr. Pousti discussed her symmastia, her breast asymmetry, her bottoming out and the combination of capsulorrhaphy (placement of internal permanent sutures) and the use of additional supportive material such as AlloDerm or BioSynthetic Mesh were discussed.

Dr. Pousti decided to use TIGR Mesh which is a BioSynthetic mesh that is non-human / non-pig but will provide additional support for this patient’s breast pocket repair.  The measurements and markings are performed on the morning of the surgery and Dr. Pousti reviews all the procedures that will be performed.

The red shaded area shows where the breast pocket is going to be closed off through capsulorrhaphy. The capsulorrhaphy procedure, also known as pocket correction or use of internal sutures/bra, involves closing a portion of the breast pocket to correct displacement of the implant.

Below shows the right breast after capsulorrhaphy. The intra-operative sizer is used to assist Dr. Pousti in determining the best sized implant to help the patient achieve her goals.

The Tigr Matrix Mesh is used to help add additional support to the breasts. Tigr Matrix surgical mesh is a degradable surgical matrix made from synthetic resorbable polymers intended to support and reinforce tissue for 6-9 months and be absorbed completely by the body after 3 years.

The patient is shown below immediately after breast revision surgery surgery. She has bilateral 415cc high profile Sientra silicone gel breast implants.

The bolster dressing is used as a support between the breast implants to assist in preventing a recurrence of implant displacement.

This 27 year old patient from San Jose, California previously had breast augmentation surgery with a local plastic surgeon. She was unhappy with the results and wanted to find a plastic surgeon that could help correct her symmastia.  She met with Dr. Pousti and discussed revisionary breast augmentation surgery with Dr. Pousti and after evaluation, Dr. Pousti recommended capsulorrhaphy as well as the use of Allograft with this patient.

The capsulorrhaphy (internal bra) in performed by placement of 2 layers of permanent sutures in the capsule which has formed around the breast implant to create a new “pocket” for the breast implant and improve the positioning of the breast implants on the chest wall. As you can see above, the nipple/areola complexes are not centered on the breast mound – they are pointing outwards.  Once the placement of the implant is corrected, the nipple/areola will be more centered on the breast mound.

Dr.Pousti performs markings and measurements the morning of surgery. He also likes to go over the patient goals and any questions or concerns they may be having before the surgery as well. The shaded “red” are the areas where the internal capsule work will be performed to improve the breast positioning.

ADM has many indications for use; additional coverage, additional support, improve rippling, reduce recurrence of scar tissue formation and more.  In this patient’s case, the Acellular Dermal Matrix (ADM) will be used for additional support in the cleavage area to make the internal suture repair as strong as possible for symmastia correction.

Strattice™ Reconstructive Tissue Matrix is an acellular reconstructive tissue matrix designed to support tissue regeneration. It is derived from porcine dermis, which undergoes non-damaging proprietary processing that removes cells and significantly reduces the key component believed to play a major role in the xenogeneic rejection response.

This is the patient directly after surgery.  As you can see, the implant positioning as well as the nipple / areola positioning are significantly improved.

She has 300 moderate plus silicone implants. She is doing well and has no complications.

This 39 year old patient from Westminster, California has been considering revisionary breast surgery for years.  At her consultation, she and Dr.Pousti discussed her breast implant deflation as well as symmastia repair.

Positioning of the breast implants can be improved with the capsulorrhaphy (internal bra) procedure.  This is when Dr. Pousti places 2 layers of permanent sutures in the capsule that has formed around the breast implant to create a new “pocket” for the breast implant and achieve better placement of the implant on the chest wall.

Dr. Pousti performs markings and measurements the morning of surgery. He will discuss the procedure in detail as well as go over the potential risks and complications associated with the procedure one more time with the patient.  It is very important that the patient have realistic expectations after revisionary breast surgery.

The shaded areas  (red) are where the internal suture work will be performed to improve breast implant placement.

This is the patient directly after surgery with 44occ high profile silicone gel breast implants. She is doing very well with no complications or concerns.

This 44 year old patient from Fresno, California suffers from congenital symmastia .  She was interested in having her cleavage area improved as well as having breast implants placed for more upper fullness of the breasts.   Dr. Pousti discussed options with the patient regarding her congenital symmastia and the patient had realistic expectations for her results.

The first stage that would be to perform is breast augmentation and liposuction of the cleavage and sternal areas. Below is the patient’s post op photos after surgery #1 – still very fresh in the recovery stage.

This first surgery (placement of breast implants) would allow a capsule to form around the breast implant (this capsule strengthens with time) and after the capsule is strong enough, Dr. Pousti can then return to the operating room and place internal sutures (capsulorrhaphy) to improve the contour of the breasts and cleavage area with revisionary breast augmentation surgery. Below is the patient 1 year post op breast augmentation / liposuction of the cleavage area.

After being examined by Dr.Pousti he believed she showed signs of significant improvement. They discussed the next surgery that would involve the internal bra, removing some breast tissue to help define the breast a bit more, and also exchanging her implants. After discussing all options she was ready to move forward with the second stage of the surgery. She scheduled her surgery date soon thereafter.

Dr.Pousti performs markings the morning of the scheduled surgery and they went over the procedure one more time. They also discussed post surgery instructions as well and he answered any additional questions that the patient may have had before they proceeded to the operating room.

This is the patient immediately before her surgery. She has been prepped for surgery and markings have been completed. The red area between the breasts  is where the internal bra will be placed so as to create cleavage or space between the breasts. It also shows that she currently has 335cc silicone gel implants and these implants will be removed and replaced with high profile breast implants.

Above, is an illustration of the breast/soft tissue that was removed from the pre-sternal area of the patient to help create more definition between the breasts.

This is the pateitn immediately after her surgery. She had an internal bra placed between the breasts and tissue was also removed as to create more space between the breasts. She also had her implants exchanged. She went from 335cc to 325cc smooth round high profile silicone gel implants produced by the Mentor corporation. Below, is the patient 4 days after her surgery and she is healing very nicely and without any complications. She will continue to follow-up with Dr.Pousti throughout her recovery process.

This 50 year old patient from Orange County, California had been thinking about revision breast augmentation surgery for many years.  She was unhappy with the results of her previous breast augmentation surgery (performed by a different surgeon).  She did her research to find the best breast revision surgeon to help her achieve her goals.

She had implant mal-position – bottoming out and symmastia.  After discussing her goals with Dr. Pousti, it was determined that she would need to have the internal bra (capsulorrhaphy) to improve the bottoming out and symmastia as well as the use of ADM (Acellular Dermal Matrix) for both breasts.

The “green” markings below show the area medially where Dr. Pousti performed the internal capsule work to improve the contour of her cleavage.  He also performed the 2 layered technique with permanent sutures to improve the bottoming out of the breast implants.

The patient’s breast implants were removed and capsulorrhaphy was performed and ADM was placed (see below) to have a solid foundation for the placement of the new breast implants.

Temporary sizers were placed (see below) to evaluate the position, size and symmetry of the breasts before the breast implants are chosen.

Below you see the patient immediately after her revisionary breast surgery with  an amazing improvement.

Breast augmentation revision surgery, correction of breast implant displacement medially and inferiorly, placement of 700cc silicone gel breast implants.

Patient Review:

After having BA and 2001 I was very disappointed with the outcome. I had gone to a doctor in Newport Beach he had put in 700 cc ‘s which I was happy with the size but they were a low profile and wrong for my 27 inch rib circumference. I developed a condition called symmastia, which left me with no cleavage at all, I was very self-conscious about it and couldn’t wear a lot of the cute tops my friends were wearing and only certain bathing suit tops. In 2008 I decided to try to fix this problem I went to a new doctor in Orange County who thought he could fix it I had the surgery and still the symmastia was exactly the same, not only that I obtained an infection which lasted for three months. I lived with this for another 9 years and as my 50th birthday was approaching I thought there has to be surgeon somewhere out there that could make this right, so I began my extensive research spending hours on the internet reading reviews and about different doctors knowledge on the subject. I went to 5 different consultations from Los Angeles to Orange County and the I found him Dr Pousti in La Mesa, even though I live in La Verne I was willing to make the 2 1/5 hour drive to meet him. Everything I read about him was very impressive, he was super knowledgeable and I was very impressed with the before and after photos. I made an appointment and knew right away this was the doctor I had been searching for, he and his staff were amazing. He explained in detail what needed to be done and was confident he could achieve what I was hoping for. He made me feel very comfortable with his experience dealing with the symmastia condition and answered every question honestly, and believe me I had a lot. The whole staff was super friendly and Daisy spent extra time with me showing me many before and after pictures and explaining what to expect during and after the surgery. I can’t say it enough I’m sooooo happy I went with Dr Pousti, he truly is blessed with a talent and a true artist!!!!

After living with this condition symmastia for 15 years I finally found a Doctor Who over exceeded my expectations. Dr. Pousti made me feel 100% confident with his knowledge and experience. The whole experience for me was amazing everybody at the surgery center was awesome and I’ll never forget after I woke up from surgery Dr. Pousti was standing there and told me he was able to give me the best of both worlds, the size I was hoping for and fixed the symmastia, and the bottoming out problem. I was told there was a possibility I would have to downsize to fix the problem and I was prepared for that, but he was able to do both keep my size and fix the problems, amazing!!!! It’s been exactly one week today and I’m feeling great I still have to keep my arms down take it easy but I’m so happy with the results.