What Is The Cause of Symmastia? What Can I Do Now? (photo)

I went to several ps in person that confirmed that I do have synmastia. Right now it is mild-moderate but can get worse if not fixed. I'm debating weather to just get them removed instead of going through what I hear is a semi difficult surgery especially if you can not find a surgeon that performs synmastia repairs. What is the cause of synmastia exactly?

Doctor Answers 12

You do not have symmastia

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Your picture shows that you have mild pectus excavatum. This chest wall deformity has caused medial shift of the implants. This can be corrected by the implant repositioning ,but I would suggest to leave it alone. The depression in your mid chest will cause implant shift post revision. The other concern is that your implants are too big for your chest and breast, going smaller will help.

New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Symmastia correction

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From the photographs this does indeed appear to be symmastia.  Correction usually will involve reduction in the base diameter of the implants, replacement of the implant in a different plane, elevation of a capsular flap or medial acellular dermal allograft placement.  

Glynn Bolitho, PhD, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews

Correction of Medial Breast Implant Malposition?

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Thank you for the question and pictures.

Medial breast Implant malposition Is one of the potential implant malposition problems that can occur after breast augmentation surgery.   It is potentially worse by use of larger implants in thin patients, and is a problem for implants over or under the muscle, though sub muscular implant placement allows the muscle to provide some softening of the transition to the cleavage area from the augmented breast mound.

Correction involves use of internal sutures of the capsule around the breast implants. Often, it is necessary to expand the breast implant pocket laterally (outwardly) to allow for correct placement of the implants.  In recurrent cases,  the use of a sailor dermal matrix may be helpful.

If you do choose to have the breast implant malposition corrected, make sure you are working with a well experienced board-certified plastic surgeon who can demonstrate significant experience with this type of revisionary surgery.

I hope this helps.


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Hello Courtney,

You and your previous surgeon thought it was a good idea to choose that particular sized implant, which your surgeon realized later that it wasn't, unfortunately while you were on the operating room table.  Repair is difficult but not impossible.  The most reliable repair technique does NOT rely on internal sutures that break or pull through, but instead on recreating a new sub-pectoral pocket (aka: neo-submuscular pocket).  The cornerstone to success for you lies in reduction in the size of your implants by 40% to 50%.

Needless to say, you should search out a surgeon with a great reputation for complex breast revision surgery. This surgeon would also be certified by the ABPS, and a member of the ASAPS.  I would not give up and remove your implants, but I also would really do the footwork to find the right surgeon to do this repair.  In the end you will probably be happy.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews


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Thank you for question and for the photo. In my practice I tell my patients that problems tend to occur when larger implants relative to the size of the chest and the breast are chosen. You can imagine that a smaller implant with a shorter base diameter would have less of a chance of this problem.

Essentially a new pocket under the muscle needs to be made which would leave a wider space between the implants in order to avoid this occurring again. I would also recommend a smaller implant with a shorter base diameter.

I recommend seeing 2 or 3 board certified plastic surgeons to discuss the options.

Ralph R. Garramone, MD
Fort Myers Plastic Surgeon
4.8 out of 5 stars 69 reviews

Does Not Appear to be Symmastia But Best to Consult with Surgeon

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Symmastia is a condition which can occur when the implants are too close together. Patients often refer to this as a “uniboob.” Occasionally, the space or pocket for the breast implant is created towards the center, or the tissue stretches, forcing  the implants to fall too much towards the center of the breasts. However, #symmastia is not apparent per your photos at this time.  Your case appears that the breast implant #position and #sizing may be matters of concern. If you are not satisfied or if this concerns you, it's best to consult with your plastic surgeon to further discuss your #options.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

What causes Synmastia?

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Synmastia is a condition which can occur when the implants are too close together. Patients often refer to this as a “uniboob.” During breast implant surgery a pocket is created carefully to maintain certain folds on the sides and bottom of the breast. On occasion, the space for the breast implant may shift 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.

#breastrevision #breastimplants

Symmastia Causes

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Thank you for your question. Symmastia is a serious, but rare complication that can occur after breast augmentation. The problem occurs when the breast implant crosses the midline between the breasts, essentially joining the breasts together. Symmastia can be obvious or it may be subtle, becoming visible only when the patient is lying down. The basic causes of symmastia are oversized breast implants and over-dissection of the breast pocket. Symmastia is often seen when progressively larger implants in multiple breast augmentation procedures.


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Symmastia is the result of the implants migrating medially and lifting the central chest skin.  If the implants are subglandular, a new pocket under the muscle will be beneficial. Sometimes the pocket needs to be clsoed down medially and alloderm/strattice can be placed. the lateral pocket can be opened and a smaller implant placed.  But your photos do not look like a true symmastia.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Symmastia can be hard to correct

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Having been referred 5 patients that I can think of, this is a difficult problem, but not as bad as you are led to believe.  The usual problem is too much dissection medially moving the implants too close together.  This combined with large implants are a set up.  You don't say how soon after surgery this occurred.  If I were treating you my plan would be smaller implants, more lateral dissection, a capsular flap to wall off the implants and the use of Strattice or Alloderm to reinforce the repair.  In my hands I have had good success with this treatment plan.  You might want to see several doctors before deciding what to do.  Good luck, Dr. Schuster in Boca Raton.

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.