‍What is Breast Implant Symmastia and How Do You Fix It?

Dr. Robert Schwartz

December 21, 2022

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‍What is  Breast Implant Symmastia and How Do You Fix It?

Considering breast augmentation surgery? You might have heard of a deformity called symmastia. Perhaps you’ve had a breast augmentation procedure that resulted in symmastia. In this post, we’ll explain everything you need to know about this cosmetic surgery complication. If you’re planning a breast augmentation, we’ll recommend steps you can take to avoid developing symmastia. And if you already suffer from symmastia, we will explain breast revision surgery options for symmastia repair.*

What is Symmastia?

Symmastia is also called synmastia or breadloafing and is one possible complication that can occur from a previous breast augmentation surgery. Symmastia happens when one or both implants have been placed too close to each other and the tissue that separates them is stretched or merged. The skin lifts off the underlying sternum (breastbone). This causes a patient’s breast to connect in the midline, giving them the appearance of one breast (uniboob).

Symmastia - Note the raised skin between the breasts

What causes symmastia?

Improper Pocket Creation

Most often, symmastia occurs when the surgeon misjudges where to stop the inner edge of the implant pocket. If the pocket goes too far in, it can merge or overlap with the other side’s implant pocket. This causes the breasts to connect in the middle.

Over-The-Muscle Placement

Placing the implants over the muscle (subglandular) raises the risk of symmastia. Your pectoral muscle attaches to the outer edge of your breastbone. By preserving those pectoral muscle fibers, your plastic surgeon adds another layer of protection against symmastia.

Larger Breast Implants

In our experience, all women can choose from a variety of breast implant sizes and styles. But for most patients, there is an upper limit to the size they can hold. If the implant is too wide for the woman’s frame, the pocket may have to extend too far toward the center of the chest. The larger breast implants can also exert too much pressure on the skin and muscle of the central chest tearing it loose. Either of these situations can produce symmastia.

Narrow Sternum (Breastbone)

The attachment of skin and muscle to the sternum is what prevents the two pockets from merging. A narrow sternum offers less area for strong skin fixation and raises the risk of symmastia.

Pectus Excavatum

Pectus Excavatum is a chest deformity where the sternum is sunken inwards. This condition narrows the space between the breasts, raising symmastia risk.

Woman with pectus excavatum

Poor Structural Support

Aging, poor nutrition, lack of exercise, or unlucky genetics can weaken muscles and connective tissues. The skin less tightly connected to the cleavage area can lift off the chest wall more easily, causing symmastia.

Aggressive Massage

We are not fans of postoperative breast implant massage for a wide array of reasons. This is one of them. Your healing breast tissue is delicate and can be injured or torn by rough massage. And that tear can produce symmastia.

Bad Surgical Dressing

Like overly-forceful massage, a poorly fitting compression bra or excessively tight dressing can push your breast implants toward each other and cause you to develop symmastia.

What are the Options for Correcting Symmastia?

Non-Surgical Correction

If symmastia occurs shortly after a breast augmentation procedure, it can sometimes be successfully treated with postoperative intermammary compression. This is a fancy name for using a special bra that pushes the cleavage skin against the breastbone. Held in place like this, the skin will sometimes adhere to the bone producing a permanent correction.

Examples of compression bras used to correct symmastia
Examples of compression bras used to correct symmastia

Reconstructive Surgery

Most symmastias will need to be surgically corrected. There are several options for this type of breast reconstruction. All are designed to close off the excess inner edge of the pocket but vary in the way the closure is done.

The anesthesiologist will put you under general anesthesia. Your surgeon will temporarily remove one or both breast implants to expose the pockets. The opening over the sternum is then closed with slowly dissolving or permanent internal sutures. This technique, capsulorrhaphy, was the original and remains the most common method for fixing symmastia.

Some surgeons reinforce this repair with synthetic mesh. This is called an internal bra procedure. As we discussed in our double bubble blog, we try to avoid mesh because it is expensive, doesn’t necessarily strengthen the repair, and introduces its own potential complications.

We prefer to use the scar tissue from the patient's own implant capsule to create the internal bra. This is called a neopocket procedure. It’s a more reliable and precise method for correcting symmastia than capsulorrhaphy or mesh repair.

We recommend the neopocket repair whenever it is anatomically possible. If the scar capsule is not usable, we perform capsulorrhaphy and add mesh only for particularly fragile repairs or symmastias that have recurred after previous corrections.

What are the risks of Symmastia Repair?

Since a symmastia correction is an invasive surgery that requires general anesthesia, it comes with the same risks as any other cosmetic surgery (bleeding, scarring, infection).

But the most important potential complication of symmastia surgery is a partial or total reappearance of the symmastia. Symmastia is one of the most dreaded complications in plastic surgery. It’s because the corrective surgery can be technically challenging, and even when performed by an experienced plastic surgeon, the repair can fail.

If your symmastia repair fails, your plastic surgeon should consider temporarily removing your implants as part of the next breast revision surgery. This will make the pocket closure reliable. The implants can be replaced at a second breast surgery 3 to 6 months later. If they were too big, smaller implants should be used.

How can I  Prevent Getting Symmastia?

If you want to avoid symmastia (and other complications), choose a board-certified plastic surgeon with extensive experience in breast augmentation and breast implant revision surgery. Make sure your surgeon isn’t planning to give you larger implants than your chest size permits. Your ideal doctor should also be willing to discuss your aesthetic goals and answer any questions you may have.

How Much Does Correcting Symmastia Cost?

The price for symmastia breast implant correction surgery depends on the level of difficulty, what type of revision surgery is needed, and if one or both breasts require treatment. Usually, our symmastia surgeries cost $6000 to $13,000.

The surgeon’s fee, anesthesia fees, operating room costs, and postoperative care are all included. In complex cases, symmastia repair can require more than one procedure. Here, the total cost to the patient might be higher.

Summary

Symmastia is a rare condition that can occur as a complication of breast augmentation. Patients with symmastia will have one of both breast implants extend to the middle of their chest or even to the other side. The underlying problem is that the implant pocket extends too far into the cleavage area. This can happen during surgery due to poor technique or during the recovery process.

Regardless of the cause, most symmastias require additional plastic surgery to close the excess pocket. Though the idea behind the repair is straightforward, the surgery itself can be technically challenging. Though most symmastia surgeries are successful, this cosmetic procedure has a relatively high failure rate. Ideally, you want your symmastia surgery performed by a surgeon experienced in this and other breast implant revision techniques.

Please call or text us if you have symmastia or other problems with your implants. Every year, we help hundreds of women become proud of their breasts.

*This article is about symmastia resulting from breast augmentation procedures (iatrogenic symmastia.) The type of symmastia that occurs as a birth defect (congenital symmastia) is different and requires other types of corrective surgery.

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