Do I have symmastia and should I consider a revision? (photo)

Question

I'm 3 weeks away from 6mpo. Does this look like symmastia? Should I ask for revision, if so, how do I go about doing that?

Semih Yildiz, MD, FEPOBRAS · Answer

A single photo can raise the question of implant position, but it is not enough to diagnose symmastia. In your photo, the breasts do appear close in the midline, but true symmastia is usually judged by whether the skin over the breastbone is lifted or tented and whether the implant pockets cross too far toward the center. That has to be checked in person, often while you are standing, lying down, and moving your arms.

At almost 6 months, this is a reasonable concern to discuss with your surgeon. The key questions are whether there is medial pocket over-dissection, implant malposition, or simply close cleavage/settling. If true symmastia is present, correction may involve an internal pocket repair, capsulorrhaphy, reinforcement with an internal bra or mesh in selected cases, and sometimes implant size or pocket changes. The exact plan depends on your tissue quality, implant size, pocket plane, and exam findings.

Unless there is pain, skin thinning, infection, or a rapidly worsening change, revision is usually planned after the tissues have stabilized, often around 6 to 12 months or longer. An in-person assessment with your original surgeon, and possibly a second opinion from a board-certified plastic surgeon who does revision breast surgery, would be the safest way to decide whether revision is actually needed.

Gianfranco Frojo, MD · Answer

Yes, this does appear to be symmastia. I would discuss this with your surgeon as this is clearly not the outcome you were seeking.

Daniel Barrett, MD · Answer

Dear Terrific62548,
symmastia is a rare breast condition that occurs when soft web-like breast tissue pulls breast implants towards each other, until the breasts meet uncomfortably at the center of the chest near the sternum (the body’s midline point). Given this abnormal union, symmastia is known by many other names, including breadloafing, kissing breast implants, and the uniboob.Unfortunately, this condition causes the surrounding skin and pectoral muscles to literally lift off the breast bone as the implants are pulled together. This consequently causes pain and discomfort, as well as obvious distortion of the breasts, which can only be disguised with clothing that does not show cleavage.You should consult with a board certified plastic surgeon for proper assessment. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Brian K. Reedy, MD · Answer

Thanks for your question! It would be helpful to see before photos, but you do appear to have symmastia. I would simply suggest bringing it up in your next follow-up appointment. Your PS likely has a revision policy. It couldn't hurt to get a second opinion as well. Good luck!

Connie Hiers, MD, FACS · Answer

You will need more than just the one photo to determine if you actually have symmastia. Also, please post your before photos as well.  I would suggest discussing your concerns with your surgeon.

Camille Cash, MD · Answer

An exam is needed to know for sure but from the submitted photo it does appear you may have symmastia.  I encourage you to return to your surgeon for an evaluation and discussion of options.  As you are six months post op you can consider a revision at this time.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment regarding the outcome of any plastic surgery procedure, which generally always need to see a complete set of proper before and after pictures.
If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took.
Synmastia can sometimes be diagnosed by pictures and other times we need an examination as well to see how high the skin is from the sternum.
Seeing what you look like before surgery would be the most telling.
If you have this condition and want it corrected. Then the next step would be to find out, if your provider has sufficient experience correcting this condition.
It is a difficult condition to correct with long-term quality outcomes. If you’re provider and offers to correct it, then ask your surgeon to show you their entire collection of before, and after pictures of previous cases who had the same situation
Understanding your full breast, history in regards to previous procedures, would also be very important.
Best,
Mats Hagstrom, MD

Do I have symmastia and should I consider a revision? (photo)

Answers (7)

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