Symmastia After Breast Augmentation

Symmastia is a breast deformity in which the natural separation between the breasts disappears or is compromised.
Acquired symmastia refers to symmastia that occurs after breast augmentation, while congenital symmastia is present at birth and seen in people who have not had breast surgeries.
Plastic surgeons can repair symmastia, and doing so may require making changes to the implants themselves or to the implant pocket.

What is Symmastia?

Symmastia is a breast deformity in which breast separation is lost, making the breasts appear to connect across the center of the chest. The slang term for the condition is “uniboob,” borrowed from the term “unibrow.” (Think Bert from “Sesame Street.”) Sometimes, patients with breast implants develop symmastia when one or both breast pockets sit too close to the center of the chest. This is called acquired symmastia.

There is also a rare condition known as congenital symmastia. In this disorder, symmastia is present despite a lack of prior breast surgeries or breast augmentation. Congenital symmastia connects the breasts through skin or breast tissue itself and is present at birth, although it may not be noticeable until puberty when breast development begins.

Why Does Symmastia Happen After Breast Augmentation?

To be clear, symmastia doesn’t always happen after breast augmentation and is actually quite uncommon. There are several different reasons for symmastia, however, and your plastic surgeon will want to determine the cause so that they can apply the proper correction.

Implant Pockets Extend Too Far Toward the Sternum

A breast implant pocket normally has a boundary that helps preserve your natural cleavage. If the pocket is made too large, or if it stretches after your breast augmentation, one or both of your implants may move toward the center of your chest. This, in turn, pushes the tissue over your sternum up and away from the chest wall, reducing or eliminating normal breast separation.

Implant Size and Width

Choosing implants that are too large for your chest can also create symmastia. Oversized implants place more stress on the implant pocket, which could be pushed inward toward the center of your chest. It’s not just implant volume that you must consider. Implant width, implant projection, and skin quality all play a role. You must have enough space and breast tissue to accommodate a large implant without compromising the separation of your breasts.

Tissue and Muscle Support

Thin, weak skin and breast tissue may provide less support for breast implants, increasing the risk of implant displacement. Symmastia can also occur with implants placed under the muscle, particularly if the implant pocket extends too far toward the sternum, or if the chest muscle attachments along the sternum are disrupted. The risk may also be higher in patients who have undergone multiple previous breast augmentation or revision surgeries.

What Does Symmastia Look and Feel Like?

If you are experiencing acquired symmastia, you may notice it in both the physical appearance of your breasts and in odd feelings or sensations in the area. You won’t necessarily have every sign or symptom of symmastia, but if a few of the items in these lists look familiar, you could have the condition. Appearance-wise, symmastia usually looks like this:

  • Little or no defined cleavage between the breasts
  • The breasts appear connected across the sternum
  • Skin between the breasts lifts away from the chest wall (breast tenting)
  • Implants appear unusually close together
  • One implant moving more toward the center than the other
  • A distorted or unnaturally narrow cleavage line
  • Loss of the normal flat area over the breastbone
  • A tented or webbed appearance between the breasts

You may also notice the following physical symptoms:

  • Tightness or pulling near the sternum
  • Tenderness or discomfort
  • Pressure between the breasts
  • Difficulty maintaining natural breast separation in bras or clothing

Symmastia vs. Naturally Close-Set Breasts

Not everyone whose breasts are close together has symmastia, and it’s important to make the distinction. Naturally close breasts may have narrow cleavage, but the skin between them still lies flat against the sternum, even if there isn’t a lot of it. In symmastia, this flat area of skin is entirely or partially lost. If you’re not sure if you have true symmastia or your breasts are just close, a plastic surgeon can evaluate you, sometimes by simply comparing your current anatomy to your anatomy prior to your breast augmentation.

How is Symmastia Repaired?

The specifics of how symmastia is repaired vary from one patient to the next based on the reasons for their breast deformity. Tweaking the implant isn’t enough — a surgeon must correct the underlying cause of symmastia so that it doesn’t happen again. Potential corrections include:

  • Closing or tightening the medial implant pocket with capsulorrhaphy
  • Creating a new implant pocket
  • Reattaching or reinforcing tissues along the sternum
  • Repositioning the implants farther apart
  • Downsizing implants if they are too wide or heavy for the patient’s anatomy
  • Changing implant plane when appropriate (changing under or over the muscle placement)
  • Removing excess medial tissue
  • Using internal reinforcement when tissue quality is poor
  • Removing implants entirely if the patient no longer wants augmentation

Capsulorrhaphy and Pocket Repair

Capsulorrhaphy is a fancy way of saying that your plastic surgeon uses internal sutures to close off an oversized or poorly positioned implant pocket, preventing future implant shifting. For symmastia, the repair focuses on restoring a firm boundary, preventing the implant from moving toward the middle of the chest.

Changing Implant Size or Placement

If the implants are too large or wide for your chest, your surgeon may replace them with smaller, narrower implants as part of your symmastia correction. This reduces pressure on the implant pockets, preventing them from stretching and allowing the implants to move inward. Your surgeon may also recommend changing from above-muscle placement to another implant plane or creating an altogether new implant pocket.

Repairing Congenital Symmastia

Congenital symmastia requires a much different treatment strategy because there are no implants to resize or implant pockets to repair. Treatment is highly individualized because congenital symmastia anatomy varies considerably. Some approaches involve removing excess tissue between the breasts, attaching the skin to the sternum, and postoperative compression garment wear. Liposuction is also used to remove excess tissue between the breasts prior to attaching the skin to the chest.

Can Symmastia Come Back After Breast Implant Revision?

Unfortunately, symmastia can return after your implant revision if we do not address all the factors that contributed to its initial development. Solving symmastia by simply downsizing implants or fixing the pockets may not be enough. Although a combination of these approaches is generally adequate, some patients do experience symmastia a second time. Recurrent cases may require stronger internal repair, pocket conversion, implant changes, or a combination thereof.

Recurrent symmastia cases usually indicate one or more potential problems, including:

  • Weak or thin breast tissue
  • Very wide or heavy implants
  • Failure of the medial pocket repair
  • Previous repeated breast surgeries
  • Scar tissue quality
  • Chest anatomy
  • Implant pocket dimensions
  • Excessive pressure against the central chest
  • Postoperative healing and activity

Recap

Acquired symmastia is a condition in which the separation between the breasts is lost after getting breast implants. It’s usually the result of breast implants that shift toward the middle of the chest, either because of issues with the breast pocket or an oversized implant. Surgeons can repair symmastia, but avoiding recurrence requires correction of the underlying problem, whether it’s implant position, pocket dimensions, sternum attachment issues, tissue strength, implant size, or some combination thereof.

Frequently Asked Questions

Symmastia after breast augmentation is quite rare, and congenital symmastia is rarer still. It does seem to occur more often when implants are placed beneath the muscle but remains quite uncommon.

Yes, symmastia can occur in only one breast. In this case, only one implant shifts toward the middle of the chest, compromising but not necessarily eliminating the separation of the breasts. Even if both implants shift toward each other, one may not travel as far as the other.

Symmastia can appear at any time, be it weeks or years after your breast augmentation. Aging, gravity, pregnancy, weight changes, and implant pressure over time can all result in implant displacement, leading to symmastia.

Special separating bras may offer temporary support, but they can’t fix symmastia. Symmastia involves implant size or structural pocket problems that a bra cannot fix.

It could, but your implants don’t have to touch each other to create symmastia. The breasts often look connected in symmastia because the force of the implants moving toward each other tents the skin, creating a solid or connected look. Although it’s possible for your implants to touch each other, they don’t need to do so in order to cause symmastia.

Yes, symmastia can occur if your breast implants were placed too close together or your implant pockets were made too large. However, symmastia can also develop later, even when the early postoperative implant positions were acceptable. Surgical error can cause symmastia, but so can many other factors.

Symmastia itself doesn’t impact breastfeeding or nipple sensation, but breast augmentation and revision surgeries can. The risk depends on the specific techniques used during these surgeries as well as prior operations.

There isn’t a specific timeline, but it’s generally best to wait for the post-op swelling from your breast augmentation to abate. New central webbing, obvious implant migration, or loss of the normal breastbone contour should be evaluated. Symmastia should not be assumed or dismissed based solely on a set postoperative date.

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