Am I Beginning to Develop Symmastia? (photo)

I am just over 3 months post op and I know I have "double bubble" under both breasts. I am currently waiting to see if they stretch out and look better after time. But now it looks as though the weight of the breasts is causing the tissue between them to stretch and raise....what do you think? If so should i get this taken care of right away or is it okay to wait the 6 month mark for a revision? Thanks in advance!

Doctor Answers 9

About Symmastia & "Bottoming Out"

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

#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.  Currently, you do not appear to have #symmastia.

"Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.
Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant. This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold. 

Correcting such issues is based on personal choice. Additional elective cosmetic #surgery is a personal choice. Your procedures should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for a revision surgery. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Bottoming out

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The "bottoming out" phenomenon or "double bubble" that you see will almost certainly require another surgery to fix. It will not improve with just time. The timing of the surgery really does not matter, in my opinion. Choosing a smaller implant would probably be a great idea, but not absolutely necessary. I would complete a capsulorrhaphy procedure on both the medial and inferior walls of your existing implant capsular pocket. I have not seen the need to spend the money on acellular dermal matrix products such as strattice with my patients, although it certainly can be used. 

Double Bubble

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}


Although your breasts are very close, I don't think you have synmastia.

You correctly have pointed out that you do have a double bubble deformity. This won't correct itself without surgery. Having said that, I wouldn't jump into a revision operation just yet. Wait around 6 months until all the soft tissues have settled. This way the revisional surgery is easier and more predictable.


I hope this helps and good luck.


Implant Bottoming Out and Symmastia Correction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

True symmastia you do not appear to have but it is close. The bottoming out of the implants does exist and will not improve with time and is a surgical issue. Whether you opt to widen the space in your sternum when you correct the implant bottoming out will require use of implants with a more narrow base and dermal grafting. Either issue can wait until 6 months after the initial procedure if your desire.

Am I Beginning to Develop Symmastia?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

As you noted the double bubble is present on both sides, and this will require surgery. 

The implants are rather close to each other but are not touching, which is the definition of symmastia.

At the time of revision, smaller implants should be considered, as well as narrower implants. Strattice to support the repairs of both the lower and central parts of the pockets would be a good addition. I don't see an advantage of waiting 3 more months. 

All the best. 


Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Breast augmentation issues

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It looks like you have a double bubble and will need the lower capsule corrected and support placed along the inframammary fold. Perhaps the implants are also too wide for you?  This may give you the narrow sternal space.

Problems after a breast augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You have two obvious problems, the implants are low with a visible crease across the bottom and the implants are very close together in the midline.  Neither problem will likely correct themselves.   I would suspect that eventually you would need to have smaller implants the inferior capsule raised and the space between the breast widened. This may require the use of Strattise.  

Synmastia after augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Dear Busymom.  It's hard to know whether the weight of your implants is causing the synmastia or if the pockets were overdissected medially.  Either way, this is unlikely to get better and very likely to get worse.  A good supportive bra will help, but not the kind that pushes your breasts together.  You may even want to wear it at night.  Discuss your concerns with your plastic surgeon and consider getting a second opinion.  Hope this helps.

A surgical revision will be required to correct this breast augmentation result.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Both breast implants are well below the infra mammary fold.. This will not improve with time and will require an operation if it is to be changed.

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.