Symmastia or Not?

I’m really shocked about the answers of my first question: My Implants are under muscle, silicone 380 CC. I have read a lot about Symmastia but I’m not sure if I have this because I can touch my chest when I lightly press in the centre and I can see my cleavage if I contract a little the muscles.

I decide not to go bigger but I want to change the implants because they are PIP. Do I have symmastia or no ? is this grave or difficult to repair ? would Thongbra help after the revision ?

Doctor Answers (8)



Thank you for the question and pictures.

You clearly have medial breast implant malposition ( implants too close to the midline of the sternum). True “symmastia” where the breast implant crosses the midline and communicates with the other side is quite rare. Regardless of the semantics,  correction of the implant malposition is possible with an internal suture technique (two layer capsulorrhaphy)  and reverse image capsulotomy ( opening the spaces on the sides of the breasts). Keep in mind that even after correction of the implant malposition there may still be some skin” tenting”. I routinely  recommend the use  of the symmastia (thong) bra  postoperatively.

There is definitely a “learning curve” with these types of procedures  but the success rate is quite high if you are working with a plastic surgeon well experienced with these procedures. 

You may find the link attached helpful.

Best wishes.

Web reference:

San Diego Plastic Surgeon
5.0 out of 5 stars 625 reviews


Difficult problem.  I believe that based on these photos that you do have symmastia.  This is a tough problem to deal with and I think that you need to get in touch with your surgeon or a new surgeon to deal with the problem.  Leaving it alone is not an option.
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 22 reviews

Do I Have Symmastia?


Thank you for this challenging question.  I am sorry you are going to need a revision of your breast augmentation.  Symmastia is a condition where the soft tissue of the breast bridge over the sternum, therefore by definition, you have symmastia.  Interestingly, when you flex your muscles, you are able to separate your breasts, but unfortunately they go back to a symmastia position once your muscles are in a relaxed position. 

There are several procedures that will assist your surgeon in bringing your two breasts to a more natural, less connected positiion on your chest, but all procedures for correction of symmastia are moderately difficult, but I would not categorize them as extremely difficult.  Therefore, if you pick a Board Certified plastic surgeon with experience in correcting malpositioned implants, your chances of success are reasonably high.  The use of a thongbra post operatively would definitely be an advantage for keeping the medial aspect of both breast pockets closed. 

Honolulu Plastic Surgeon
5.0 out of 5 stars 153 reviews



Yes, it appears that you have symmastia.  It is moderately difficult to correct, but it can be done when your PIP implants are replaced.  A Thong bra would definitely help to support the repair.  Good luck!

Tampa Plastic Surgeon
4.5 out of 5 stars 40 reviews

Breast Implants - Symmastia, Silicone Gel


It looks like symmastia - at rest, your implants touch (ie, the skin over them touches in the midline).  That is essentially the definition of symmastia.

Correction is not impossible but it can be tricky and you, most likely, would have to agree to go with smaller implants, or at least a different profile (ie a narrower base).  In general, though, inserting smaller implants is one of the basic tenets of symmastia repair.  You may need to have some acellular dermal matrix (ADM) inserted as part of this repair.

You need to speak with a surgeon regarding this issue.  It can be fixed, but it's by no means a simple or straight-forward procedure, and you may have to compromise some of the look you have currently (ie, the size) it order to have this repaired.

I hope that this helps, and good luck,

Dr. E

Web reference:

New York Plastic Surgeon
5.0 out of 5 stars 139 reviews



I would agree that this appears to be the diagnosis. The surgical correction can be straightforward but does rely on the quality of your body tissue and the minimum size implant you are willing to accept.

Nashville Plastic Surgeon
4.5 out of 5 stars 18 reviews

Treatment for symmastia


You absolutely do have symmastia. It certainly is not 'grave' but can be somewhat difficult to treat. The pocket needs to be opened out to the side and closed next to your breast bone. Wearing the 'thong' bra can be helpful after your surgery. If you have PIP implants, you definitely should have them removed and, if they were done in the US, they should be changed by your surgeon at NO cost to you as PIP implants were never approved for use in the US. 

Columbus Plastic Surgeon
5.0 out of 5 stars 11 reviews



It sure looks like symmastia where the pockets are too close together. The pockets can be closed down a bit sometimes as well with strattice and you may be better off with smaller implants. An exam woudl be essential.

Manhattan Plastic Surgeon
4.5 out of 5 stars 14 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.

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