Symmastia or Not?

I’m really shocked about the answers of my first question: My Implants are under muscle, silicone 380 CC. I have read a lot about Symmastia but I’m not sure if I have this because I can touch my chest when I lightly press in the centre and I can see my cleavage if I contract a little the muscles.

I decide not to go bigger but I want to change the implants because they are PIP. Do I have symmastia or no ? is this grave or difficult to repair ? would Thongbra help after the revision ?

Doctor Answers 11

Do I Have Symmastia?

Thank you for this challenging question.  I am sorry you are going to need a revision of your breast augmentation.  Symmastia is a condition where the soft tissue of the breast bridge over the sternum, therefore by definition, you have symmastia.  Interestingly, when you flex your muscles, you are able to separate your breasts, but unfortunately they go back to a symmastia position once your muscles are in a relaxed position. 

There are several procedures that will assist your surgeon in bringing your two breasts to a more natural, less connected positiion on your chest, but all procedures for correction of symmastia are moderately difficult, but I would not categorize them as extremely difficult.  Therefore, if you pick a Board Certified plastic surgeon with experience in correcting malpositioned implants, your chances of success are reasonably high.  The use of a thongbra post operatively would definitely be an advantage for keeping the medial aspect of both breast pockets closed. 

Symmastia or “Mono-Breast” or “Uni-Boob” or “Kissing Implants”

Thank you for your question. If apparent immediately after breast augmentation it occurs as a result of over dissection centrally and/or use of very large based implant so that the implants are left too close in the middle. It can also develop months later but overzealous use of “push-up” bras creating thinning of tissue centrally. Either Way the condition of Symmastia is very distressing to patients.

Surgical treatment is possible but needs complex re-adjustment of the pockets using permanent suture technique and smaller size implants with narrower base.

In Mild cases a Thong Bra maybe all that is needed and avoiding push up bras.
In Moderate cases if the implants are submuscular the choices are either to suture down the tissues centrally with permanent sutures and dissect the pocket laterally so the implants have room to shift outwards. If the implants are subglandular the implants need to be placed in a new submuscular pocket.

In Severe cases the implants have to be removed for 6-12 months and replaced after pocket healing has taken place.

Post operatively ALL patients need to wear a Special Bra for 3 months with no activity

Dhaval M. Patel
Double board certified
Hoffman Estates

Dhaval M. Patel, MD
Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 79 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.


Difficult problem.  I believe that based on these photos that you do have symmastia.  This is a tough problem to deal with and I think that you need to get in touch with your surgeon or a new surgeon to deal with the problem.  Leaving it alone is not an option.

Jay Calvert, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 47 reviews


Yes, it appears that you have symmastia.  It is moderately difficult to correct, but it can be done when your PIP implants are replaced.  A Thong bra would definitely help to support the repair.  Good luck!

Stanley Castor, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 107 reviews

Breast Implants - Symmastia, Silicone Gel

It looks like symmastia - at rest, your implants touch (ie, the skin over them touches in the midline).  That is essentially the definition of symmastia.

Correction is not impossible but it can be tricky and you, most likely, would have to agree to go with smaller implants, or at least a different profile (ie a narrower base).  In general, though, inserting smaller implants is one of the basic tenets of symmastia repair.  You may need to have some acellular dermal matrix (ADM) inserted as part of this repair.

You need to speak with a surgeon regarding this issue.  It can be fixed, but it's by no means a simple or straight-forward procedure, and you may have to compromise some of the look you have currently (ie, the size) it order to have this repaired.

I hope that this helps, and good luck,

Dr. E


I would agree that this appears to be the diagnosis. The surgical correction can be straightforward but does rely on the quality of your body tissue and the minimum size implant you are willing to accept.

Treatment for symmastia

You absolutely do have symmastia. It certainly is not 'grave' but can be somewhat difficult to treat. The pocket needs to be opened out to the side and closed next to your breast bone. Wearing the 'thong' bra can be helpful after your surgery. If you have PIP implants, you definitely should have them removed and, if they were done in the US, they should be changed by your surgeon at NO cost to you as PIP implants were never approved for use in the US. 

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 35 reviews


It sure looks like symmastia where the pockets are too close together. The pockets can be closed down a bit sometimes as well with strattice and you may be better off with smaller implants. An exam woudl be essential.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews


Thank you for the question and pictures.

You clearly have medial breast implant malposition ( implants too close to the midline of the sternum). True “symmastia” where the breast implant crosses the midline and communicates with the other side is quite rare. Regardless of the semantics,  correction of the implant malposition is possible with an internal suture technique (two layer capsulorrhaphy)  and reverse image capsulotomy ( opening the spaces on the sides of the breasts). Keep in mind that even after correction of the implant malposition there may still be some skin” tenting”. I routinely  recommend the use  of the symmastia (thong) bra  postoperatively.

There is definitely a “learning curve” with these types of procedures  but the success rate is quite high if you are working with a plastic surgeon well experienced with these procedures. 

You may find the link attached helpful.

Best wishes.

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.