I Had BA Surgery One Year Ago and Ended Up with Symmastia, Severe Muscle Distortion and Possibly Bottoming Out - Any Advice?

Pre-Op I was a very small 32AA-left breast was smaller and higher than the right. Post-Op 32C-300 cc saline submuscular. Nervous for revisionary surgery-None of my problems are even anywhere close to being a permanent fix. Switch to over muscle, internal sutures, change to smaller silicone, Possibly just remove implants? Trust my PS?-He seems shocked that this happened. Could I end up in a worse position after revision? Any advice would be appreciated.

Doctor Answers 20

PHOTOS: Double bubble, bottoming out, synmastic ("uni-boob")

There are so many separate conditions that it would be difficult to fix in one stage. However, if this were your wish I would consdier a neopectoral pocket with dual plane dissection and smaller implants with possible radial relaxing incisions or fixation of the IMF with Acellular Dermal Matrix after a thorough discussion.

Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Symmastia 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.Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

When breast implants are just not working out, symmastia

With a multitude of problems after breast augmentation such as low pockets and implants that run together in the middle of the chest, symmastia, it is very understandable that you cannot trust your plastic surgeon. I feel the best choice is to remove the implants and let your chest and breast fully heal and recover, and consider replacement at a later date when shaping the pocket and positioning the implant become more predictable. Sad to start over but your present situation is dreadful.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Breast Augmentation with Symmastia, Muscle Distortion, and Bottoming Out


I'm sorry that you've experienced these complications following your breast augmentation.  However, each of these issues can be improved, but will, of course, require revisionary surgery.

1.  Symmastia-  symmastia, or "uniboob" can likely be corrected by placing your implants in a new plane (in your case, above the muscle or above the muscle but under the muscle fascia).  Using a smaller implant with a smaller base diameter will decrease the liklihood of recurrence.

2.  Muscle Distortion-  the obvious "shelf" or "ridging" that you see over the midportion of your implant with muscle contraction is likely caused by overly aggressive release of the pectoralis muscle.  To correct this, the muscle can be reattached to the sternum with permanent sutures or the implant can be placed above the muscle.  In your case, it is probably best to place the implants above the muscle as this will also address the symmastia.

3.  Bottoming Out-  the low appearance of your implants and subsequent high placement of the nipple over the implant can be corrected by raising the inframammary fold with permanent sutures.  It is possible that the excessive release of the pectoralis muscle that caused the visible muscle distortion is also contributing to the appearance of bottoming out.  Thus, reattaching the muscle to the sternum or changing the plane of the implants may treat this issue.  Again, it may also be beneficial to switch to smaller implants with a smaller base diameter.

4.  While all of these issues can be addressed, it may be rather difficult to correct them successfully in a single session or at the time of removal of your current implants.  Given this, you and your plastic surgeon may consider removing your current implants in one setting and then replacing smaller implants above the muscle six months later when your tissues have had time to heal.

5.  Finally, try to relax and be patient.  Find a plastic surgeon certified by the American Board of Plastic Surgery that you trust, and work out a surgical plan that you understand and agree with.

Jaime Perez, M.D.

Breast Augmentation Specialist in Tampa, Florida

Plastic Surgery Center of Tampa, Florida




Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 75 reviews

Treating symmastia may require the use of Strattice

Bottoming out of breast implants usually requires removal of the implants, tightening of the pocket underneath with stitches, and replacement of the implants.  For the symmastia, Strattice is a xenograft piece of tissue that can be used to "wall-off" the middle of your chest in order to prevent the implants from moving together.  The pocket tightening and Strattice placement can be done at the same time as an outpatient procedure.  Good luck!

Jeffrey E. Schreiber, MD, FACS
Baltimore Plastic Surgeon
5.0 out of 5 stars 202 reviews

Symmastia after breast augmentation

Although uncommon, symmatia can occur after breast augmentation.  Your implant diameter is too wide; and your implants are too close together.  I would use a smaller implant and utilize Alloderm (acellular dermal matrix) as a sling medially to give support.  It is a challenging problem to correct; however, it can be done.  

Sugene Kim, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 76 reviews

Synmastia Treatment

It is difficult to assess your problems from the quality of your photos.   There seems to be multiple issues going on here.   I will address the synmastia.  Synmastia is a challenging problems to fix. Synmastia clinically manifests as a "uni-breast" where the cleavage (space between breasts in the area of the chest plate) has been lost. Anatomically, usually it is because the medial aspect of each breast pocket has been over dissected or stretched out. If the implants were initially placed above the muscle, this can be improved with a site change surgery where the new implants are placed under the muscle. The sternal attachments of the pectoralis muscle will prevent the implants from coming too close to each other. However, it your implants were initially placed under the muscle, then, it is in this scenario that alloderm can be handy. Alloderm is a regenerative tissue matrix (its essentially a sheet of collagen). There are published techniques where alloderm can "recreate" and re-establish a barrier for the implants preventing them from migrating medially creating this synmastia effect. Again, synmastia is a challenging problem. But the use of alloderm has created an option for board certified plastic surgeons to improve this problem.  In addition, it will help to downsize or go with a narrower implant.  Hope this helps.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 210 reviews

Asymmetric breasts after breast augmentation

There are a number of issues evident from you photo. Muscle activation distorts the breasts, the implant base diameters are too large for your chest/rib cage size, the nipple complexes are both too far from the midline, the inframammary folds are both too low so the implants are not centered under the nipples (even if the nipples were in the proper position).  You may keep the same size of implant in terms of cc but you will need to get implants with smaller base diameters. You would need skin surgery to adjust nipple position. The implant pockets will have to be adjusted with elevation of the inframammary folds. If the capsule walls are sufficiently thick they may be sutured to allow tailoring of the pockets. If they are not you will require Alloderm or Strattice which can become expensive. It is not an easy situation to correct no matter who your surgeon is.

In Detroit you could see Dr. Kenneth Shaheen or Dr. Michael Busuito as either may be able to help you.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Breast implant revision

Many of the recommendations provided are good to consider. Give thought to obtaining a 2nd or 3rd opinion. Ask about costs of revision as some of these options require additional costly materials (AlloDerm and similar products).

Based on what you describe, your surgeon may want to consider making a new pocket for the implants above the muscle and place smaller silicone gel implants.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 68 reviews

Revision surgery is needed.

I don't agree that your implants are too large for your chest having caused this problem.  A revision surgery is needed to separate the 2 pockets but I think you can still pick how large you would like your breasts to be.  This is an unfortunate problem you have, but don't loose hope - it can be repaired.  Good luck!

Bivik Shah, MD
Columbus Plastic Surgeon
4.4 out of 5 stars 26 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.