Do I Have Symmastia? I Know I Have Bottomed Out. (photo)

I was concerned I have symastia. I have very poor skin and I know I have bottomed out. My surgery was a little over a year ago. I was a 32A with deflated breast from breastfeeding. I got moderate plus 375 saline which my ps wanted me to go with silicone due to my tissue and skin. I can lift up my skin off my bone a little bit but it goes right back to the bone. I was also wondering if i had them removed, how my breasts would look like after. Please look at my pics and tell me what you think.

Doctor Answers 11

Symmastia, No. Bottoming out, Probably...

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Thank you for the question and pictures.

Yes, I do think that your implants are too low on the chest wall. No symmastia present however.

Generally speaking, one of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).

Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. Sometimes there is associated discomfort in the are of displacement. This is corrected by “raising” the inframammary fold using internal sutures.  Sometimes, depending on the situation, the use of additional supportive material may be helpful (internal bra).  I hope this and the attached link (dedicated to revisionary breast surgery concerns) helps.

 Best wishes.

About Symmastia & "Bottoming Out"

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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.  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.

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

Do I Have Symmastia? I Know I Have Bottomed Out. (photo)

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You do not have symmastia which a one continuous pocket across the mid-line of your chest.  With removal of your implants your chest would be two lax skin flaps.  I would consider a revision.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
4.8 out of 5 stars 117 reviews


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Synmastia describes when the pockets of your breast come together and one large breast pocket crossing the midline is created.  Your photographs do not demonstrate this.  I do agree, however, that your implants have bottomed-out.  This could be corrected, if desired, by recreating your inframammary fold and reshaping your breast pockets.

It is difficult to tell how your breasts would look without implants without an examination.  If you are willing to proceed with a surgical procedure regardless, your plastic surgeon may consider delating your saline implants in the office in order for you to visualize how they would look without implants or assist you in deciding which procedure(s) would be right for you. Hope that this helps!  Good luck with your decision!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Questions about bottoming out and synmastia

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Synmastia is a condition that occurs when the two implant pockets erode into each other creating one large implant pocket.   Since there is still a small space between your breasts you do not have this condition.  You do have a small degree of bottoming out.  If you are happy with your breast condition currently then I think that you are fine  In the future if your implants continue to drift inferiorly or medially then you may be a candidate for some type of capsule procedure such as a capsulopexy or you may consider using smaller implants, or shaped textured implants.  Another choice would be to consider the use a acellular dermal matrix material such as Alloderm or Stratisse to help support your breast implant especially if you have poor skin quality.  A consultation with your plastic surgeon may help you understand your condition and suggest possible solutions.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

No Symmastia

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I do not think that you have symmastia.  The angle of your photos is not straight on, so based solely on the photos I would say you may have bottoming out.

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

Possible Symmastia and Implant Removal

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   There is no symmastia as there is a space (small) between your breast mounds.  You can get the implants removed, if desired.  You may want to consider pocket revisions to help support the implants and raise them.  If they are removed, it is difficult to predict how much the skin and tissue will retract.  The sooner after the initial augmentation the implants are removed the better the degree of contraction.  Kenneth Hughes, MD Los Angeles, CA

Do I Have Symmastia? I Know I Have Bottomed Out

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You do not have symmastia.  If you remove your implants you will have skin laxity which may return to normal after a few months.

Thomas Guillot, MD
Baton Rouge Plastic Surgeon

Symmastia After Breast Augmentation ??

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You definitely do not have symmastia. Removing your implants will not return your breasts to where they started, there will be more loose skin than before. Whether this will necessitate the need for a breast lift is doubtful but they will be more lax than before.

Not symmastia

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Your photos do not show a symmastia (uniboob) deformity.  Also, if you removed the implants you would likely return to what you were before surgery plus some new laxity in the skin.  I doubt you'd need a lift though and you'd just need to give your tissues 6 months to shrink back as well as they can.

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.