Breast Augmentation Pocket Perfection

Opinion on Breast Augmentation Pocket Perfection By Tom J. Pousti, recipe MD, F.A.C.S

By Tom Pousti, MD

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.

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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.

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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 six 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.

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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 to right), and the areola were displaced laterally on both sides. This patient is ONLY three 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.

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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.

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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 390cc saline implants. Dr. Pousti fixed the position of the pocket so that the breast implants have a natural look to them. She is one-month post op revisionary breast augmentation surgery and she loves her results.

Some patients present to our office with a desire to increase the fullness of the inferior pole of the breasts. The distance from the areola to the “new inframammary fold” is increased using gentle dissection. Use of an implant can help increase the fullness of the lower poles of the breasts. This is done routinely for patients with constricted or tuberous breasts. Tuberous breasts have a very narrow base and usually a long skin envelope. Sometimes people refer to tuberous breast shape as the shape similar to “Snoopy’s nose.” In the most severe cases of tuberous breast, a breast lift can be done through an incision around the areola, making the breast into a more rounded shape that the patient will be happy with. In many cases however, a lift is not necessary. The patient should be aware that the final result will take months to see and that they will need to be patient.

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This is a 18-year-old patient from Murrietta, California, interested in breast enlargement and found Temecula Plastic Surgeon Dr. Tom Pousti over the internet. She was looking for a very large result. She also had some constriction of her breasts and wanted the shape to be more natural. This patient is now two months post-op breast augmentation with 800cc smooth round moderate profile saline implants made by the Inamed Corporation. She is very happy with her results.

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This 24-year-old patient from San Diego, California came in to meet with Dr. Pousti regarding her constricted breasts. She has tuberous (tubular) breasts deformity and wanted breast implants to correct it. She is now about two months post-op correction of her tuberous breasts with 450 cc silicone gel implants made by the Mentor Corporation.

Some post-operative breast augmentation patients present with lateral (outwardly) displacement of the breast implants. This can be corrected using an internal suture technique decreasing the size of the pockets and moving the implants toward the midline.


This 30-year-old patient traveled from Arizona to have Dr. Pousti correct her “bottoming out” and the “lateral displacement” of her implants (left to right). Dr. Pousti performed “markings” on the patient the night prior to surgery to assist during the operation the next day.


In the operating room, you can see how the right side has been corrected and the left has not yet been corrected.

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The patient is only a couple of weeks post-operative revisionary breast surgery but very happy with her results.

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Tom J. Pousti, MD, FACS specializes in reconstructive and cosmetic Plastic Surgery and is dedicated to restoring appearance, self-esteem, function, and quality of life to his patients. After 11 years of extensive medical and surgical training, Dr. Tom Pousti is double-board-certified in General Surgery as well as Plastic and Reconstructive Surgery..
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