I had anatomical unders implants 9 weeks ago and I feel they are too close. Do I Have Symmastia?

When i lie down they seperate to about 3 finger width gap but when sat up i can fit a finger but feel i can push the area down, its as if the skin springs back. if i flex the muscles the implants do separte, could this be symmastia of will the sternum area become flatter and the gap widen as the implants and skin settle? i have been wearing a thong bra which separate then but they soon move closer if not worn.

Doctor Answers 11

You do not have symmastia

Though you do not have symmastia, your result may be improved by a revisional procedure to move the implants outward or more lateral on the chest.  Keep the dialogue going with your surgeon.  He will be more inclined to be helpful with continued, gentle reminders.  Good luck!

Greenville Plastic Surgeon
5.0 out of 5 stars 55 reviews

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Synmastia versus Uni-boob versus Webbing: Managment and treatment

Technically it depends on how you define symastia. Some define it as the implant lying on the sternum in which case you would be considered to have it. On the other hand, I have been reluctant to call it symastia unless the pockets actually communicate (aka "uniboob). At 9 weeks, given your thin body habitus, it is likely you still have swelling which can make it appear to have synmastia. Wait at least 3-4 months and continue to wear your bra. I encourage some of my thinner patients to do pectoralis strengthening to further separate the two implant pockets and minimize "webbing" of the skin which can also be confused for synmastia

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 54 reviews

Symmastia or not

No I do not think you have symmastia.  However, implants appear to be too close to the midline (immediately malpositioned). The principles we use for correction of symmastia may be applied in your case. In general I would recommend waiting nine months to one year after surgery before proceeding with revisionary surgery.

Symmastia (medial malposition breast implants) can be corrected with high likelihood of success using medial breasts implant pocket sutures  (medial capsulorrhaphy), lateral capsulotomy (if necessary), and/or the use of allograft. I do not believe that a staged procedure, involving removal of implants for period of time, is necessary.
There is a learning curve with this operation and I recommend that you seek consultation with a board-certified plastic surgeon with significant experience treating this problem. You may find the link attached below helpful.

Synmastia After Breast Augmentation??

From your pictures, it does not appear that you have synmastia.  You have a very pretty result over all, though your implants are rather close together making your nipples seem to point to the sides.

True synmastia means that one or both breast implants can be pushed past midline (i.e. to the other side of the sternum) after breast augmentation.  Your implants are very close together, but do not seem to communicate with each other.  However, some patients like this look and find it very attractive.

With time it is possible that the implants will lateralize (move to the sides) slightly and the skin between your breasts may appear more adherent to the sternum.

I recommend waiting at least 6 months from the time of your initial operation before considering any revision breast augmentation surgery.  At that time, if you are still unhappy, you and your plastic surgeon may decide to revise the breast implant pockets by make them more laterally placed on the chest wall.  This will not only provide you with breasts that are a little farther apart, but will also make your nipples appear to point straight ahead rather than out to the sides.

Jaime Perez, M.D.

Breast Augmentation Specialist in Tampa, Florida

Plastic Surgery Center of Tampa, Florida

Jaime Perez, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 37 reviews

Symmastia or not

They do look a bit close, but there is a clear separation.  It is still a bit early at 9 weeks.  Give it a few more months.  Talk to your surgeon about options.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

TOO CLOSE After Breast Augmentation

Dear Jane,

No but your implant pockets are too close.  I would recommend waiting 3-6 months before considering internal work to the implant capsule to widen the space.

You probably do not have symmastia, but...

Hi jane63kent in Belper,

From your photo and description, you do not have symmastia. Your implants are fairly close together, though. At 9 weeks from surgery, you will still have some settling occur, and the implants will likely lateralize some more. Some women desire this look; it is a matter of preference.

My only comment is in  reference to the nipple position. In you pre -op photos, you started with lateralized nipple positioning; placing the implants close to the midline further accentuates the appearance of lateral nipple positioning. Fortunately, the implants have a natural tendency to move outwards, so the appearance will improve with time.

Best regards,

Lawrence Tong MD FACS FRCSC

Lawrence Tong, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 23 reviews

Reposition implant to correct risk of symmastia

True symmastia occurs when the medial pectoral muscle is detached so that the prosthesis can ride across the sternum and meet up with the other side. From your post-operative photo it does not appear to be the case but that the prosthesis have been placed in too medial a position. If you look at your pre-operative photos the nipple areola position is more laterally placed. In these cases I explain to my patients that the prosthesis has to be placed appropriately and in a bit more lateral position so that the nipple to sternal distance is in balance with the nipple to lateral chest wall distance. This would have given you more space between the breasts and a better placement of the nipple areola complex on your breast mound. Correcting your present situation will require medial capsuloraphies and lateral release of the capsule.

Breast augmentation

I agree with you but some women like the look you have. It is good that you also sent the before picture because you had a difficult case to start with to get an optimal result. At baseline before surgery the nipples were further from the breast bone than is optimal and you had no cleavage to start with.

Aaron Stone, MD
Los Angeles Plastic Surgeon



If you gently push your breasts to the midline and the skin tents up or one of the implants appears to pass midline, this would be considered synmastia (aka symmastia). By going under the muscle we hope to avoid the implants coming too close together but it most certainly can occur. You are early in your recovery and the best thing you can do now is allow yourself to heal and wear the thong bra as much as you can and stay in close follow-up with your plastic surgeon. Although obviously not a desireable out come if it occurs, synmastia can be surgically corrected.

I wish you well.

Dr Edwards

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.