Symmastia can happen when the breast implants migrate too far toward the
midline, or when the surgeon over-dissects the medial area (or medial
displacement) in hope of creating cleavage. This complication takes on an
appearance of one breast versus two. Also known as “kissing implants”,
“bread-loafing”, and “uni-boob” – it also remains the toughest complication to
fix for a surgeon and even after repair or a reoccurrence can happen. Symmastia
is also caused by inserting too large of an implant into a patient, especially
one with thin skin.
Each patient will vary with the degree of medial displacement, so therefore the
reconstructive techniques will also vary. Normally with symmastia, it causes
severe medial displacement of the breast implants, which in turn will cause the
nipple-areola complex to appear off center on the breast mound. It is not
uncommon to see other complications occur with symmastia, including bottoming
out, rippling / and
Symmastia is caused from a couple of factors, one being the result of the loss
of tissue support along the sternal area, allowing breast implants to move
excessively towards the woman’s midline. If the pectoralis muscle that is
connected to the sternum and goes across the implant is dissected or cut during
surgery, then the implant can move toward the middle of the chest.
This complication of symmastia can result from aggressive attempts to alter a
patient’s chest wall anatomy by basically trying to increase the cleavage. It
also happens when too large of implant is used in a patient that is thin and has
a slight build. Because there might not be sufficient room for the size of the
implant, it eventually weakens the medial area with the tissue starting to lift
off of the sternum. Symmastia seems to be more common among thin women mainly
due to the fact that they have less tissue or fat covering the sternum.
Symmastia can occur with either under the muscle placement or over the muscle
placement. Having the implants place
sub-muscular, does help with providing the
patient some softening and transition to the cleavage area from the augmented
breast mound. The complication of symmastia with implants that are placed
sub-muscular always involves the muscle, however with over the muscle placement;
symmastia only involves the area of breast tissue.
Patients with Pectus
Excavatum or a
depressed breastbone are usually more prone to symmastia.
is the most common congenital deformity of the anterior wall of the chest, in
which several ribs and the sternum grow abnormally. This deformity tends to
cause the breast implants to slope more inward towards the cleavage area, which
ends up creating more pressure on the tissues in that area, and ends up
resulting in symmastia.
Pectus Excavatum is usually seen at birth and tends to
progress during the time of rapid bone growth in the early teenage years, and
sometimes does not appear until the onset of puberty.
Symmastia can be a very difficult complication to correct, one that takes a lot
of planning and also surgical reinforcement with permanent sutures of the medial
fold of the breasts. Reconstruction includes removing the breast implants and
placing internal sutures extensively in the surgical area. Because repairing
symmastia is an internal repair, the surgeon will cut away the scar tissue
inside the cleavage area and roll it back into the actual pocket that was made
for the implant to sit in. It is then that the surgeon will secure these rolls
with permanent sutures. Each side of the cleavage will have these permanent
rolls secured in order to hold the implant back. By doing this, some believe
that it lowers the rate or recurrence of symmastia from happening again.
The breast implant pocket might be laterally opened up (which is the outer
breast fold) to allow for proper positioning of the implant so that it is
centered on the breast mound. By doing this, the medial area has less stress
from the implant pressure against the medial suture line and to get a space back
in between the implants. Most plastic surgeons recommend a smaller implant to
help serve this purpose. Surgical time to correct symmastia can take 2 to 3
hours depending on the severity of the problem.
How Symmastia is repaired:
An incision can be used
either in the inframammary crease or under the areola for a clear surgical
view of the area.
The tissue that surrounds
the implant is removed in the area of the planned repair.
Tissue is sutured with permanent sutures to hold implant in place.
The incision is then
During the surgery, the
patient is held upright to assess the repair and degree of symmetry.
Multiple rows of suturing
may be necessary to achieve satisfactory repair and symmetry.
The use of tape is used to
apply pressure on the previously elevated skin overlying the sternum post
Compressive dressings and
a pressure bra are also helpful and or a
Recovery from symmastia
is longer than traditional breast augmentation, and special considerations need
to be adhered to during this time. There is slightly more pain associated with
this surgery, however pain medications manage any pain episodes. It is important
to take your medication as prescribed, and to keep all post operative
appointments with your plastic surgeon, so he can chart your recovery.
Drinking plenty of fluids will help with keeping you hydrated, and also will
help with the swelling. Bed rest and taking things very easy should be first and
foremost. Some patients can bounce back from this procedure within a couple of
week; however every patient is different with their pain tolerance.
More than likely you will be fitted into a special bra or a
during your post operative period. The “thong bra” is used to stabilize the area
after the symmastia repair. This will allow the sutured area between the breasts
to heal properly without excessive pressure being applied to the area. Your will
be instructed to wear your
for at least two – six months depending on the severity of the symmastia.
this way will help
apply constant pressure on the repair so that it has the best odds in healing
with keeping the area stable.
Patient wearing thong bra after Symmastia revision surgery
You will not be able to shower until your sutures are removed as most like to
keep the sutures dry, and your plastic surgeon could have used drains to help
with the swelling. To read more about drains, please go to this link.
a symmastia repair, the implant placement on the chest wall could be
a little bit higher. This is caused from swelling and also all the suturing that
was done. In time, the implants will drop into a much more natural