Symmastia After Breast Augmentation

I had breast augmentation in 2006. My surgeon quickly noticed that I had symmastia and had told me that it was no big deal and it should improve over time. Then in July of 2008 he suggested to me that he could put sutures in the middle and change my implants to fix it and I only would have to pay the anesthesia and for the new implants.

Well it’s been 7 months and I still have the same problem except that I have bigger scars on my nipples and scar tissue on my right nipple that causes it to point down. What do I do? Please help!

Doctor Answers 13


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.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Synmastia is very hard to correct

Some patients have an anatomical predisposition to central migration of their implants if they have an inward angling chest wall. In these patients, a good gap between the two pockets assists in preventing synmastia. Sometimes, the pocket is incorrectly dissected and sometimes a patient can be too vigorous in massage or wear push up garments too early and brake down the barrier above the sternum.

Fortunately, synmastia is rare because it is very difficult to treat. Probably the two best ways to address it are to do a staged procedure with implant removal followed a few months later with smaller textures implants. The other way is to develop an entirely new pocket for the implant either above or below the muscle. Good luck!

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Synmastia Treatment

As my colleagues have stated, 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.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 209 reviews

Synmastia blues

Asian Redneck (I love it),

Synmastia is a vexing problem that is sometimes difficult to fix. I would assume that a capsulorrhaphy (stitching closed the capsule that contains your implant) was done at the time of your correction. This may be an incorrect assumption, and if it is, may work to your benefit. If your capsule was not closed, then you may still be able to have this done. Talk to your surgeon about whether this was attempted or not. If not, he/she may be willing to go in again. Regarding the scarring of your nipple, there is still time for this to improve. Massage the scar tissue daily with moisturizer to soften and release it. Good luck!

Kenneth R. Francis, MD, FACS
Manhattan Plastic Surgeon
4.6 out of 5 stars 47 reviews


Symmastia is a condition which can occur when the implants are too close together. Patients often refer to this as a “uniboob.” This can occur for the same reasons as displacement noted above, but in this case the pocket(s) is/are too far towards the center.
Correction of this problem may involve using different implants such as textured, a smaller size, or a smaller base and placing the implants in a new pocket. On occasion, this may require surgery in more than one stage to allow the tissues to heal and then place the implants. If the implants have been placed above the muscle, converting them under the muscle frequently will help and, again, the use of a dermal substitute may be required for additional support if the tissues are thin. The techniques of capsulorrhaphy and neopectoral pockets may apply here as well.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Symmastia after breast implants can be corrected,


I don't quite agree with my colleagues. Symmastia after breast augmentation can be reliably corrected and it is not that hard.  The surgeon has to create a new implant pocket or "neopocket" for the breast implants, and the new pockets don't come anywhere near each other.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Symmastia is not easy to repair.


As the other surgeons here have noted symmastia is not easy to fix. You probably need more surgery and smaller implants. The ways to fix this are not standard. See your surgeon and make a game plan.

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 27 reviews


Symmastia is a condition that can be very difficult to treat.  The easiest way to treat this is by switching from a subglandular pocket to a submuscular one. It also may help to use smaller implants if they are quite large.  Suturing the pockets in the midline can help  for specific conditions.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Symmastia is a very complex problem! Continue to see your plastic surgeon.

Thanks for your question. I think it is imperative that you continue to follow up with your plastic surgeon. He certainly understands your anatomy and the procedures he/she performed. Everyone agrees that symmastia is a very complex problem. It sounds from your description that revision surgery is required and may take more than one procedure.

Depending upon your examination and clinical findings, you may be required to dramatically reduce the size of your current breast implants or remove them totally. Again, please see your treating plastic surgeon to discuss your concerns!

I hope this helps to explain your concerns.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Synmastia is a challenging condition

Synmastia is difficult to treat. It may require more than one operation and as my colleagues have stated, there are many options and sometimes different procedures may need to be performed in order to correct. These include:

1. Removal of the implants at procedure;

2. Using textured implants (these have a tendency to "velcro" in place) avoiding surgery near the breast bone (sternum)

3. Removal and Replacement of the implants in a new location i.e. "overs" to "unders"

4. Use of tissue flaps to close off the pockets also called a capsulorrhaphy

5. Use of biologic materials to seal off the tunnel.

Discuss these options with your surgeon.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 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.