Symmastia/Revision Questions? (photo)

Hi, I'm a transgender woman, I had a breast augmentation done May 8th 2012. I had absolutely no breast tissue prior to my surgery. My doctor decided on 700cc high profile, smooth cohesive gel implants placed under the muscle, through the areola. 3 weeks after surgery I noticed (and he later confirmed) I developed symmastia. I want this fixed, and I want natural looking breasts. My question is, should I go back to him? or should I find a specialist in symmastia correction?

Doctor Answers 8

Symmastia after breast augmentation for gender reassignment

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I have been working with transgender patients for over twenty years.  The results you have (symmastia) occur when the muscle attachments near the midline are over-released. Correction is possible but requires a significant amount of work to re-attach the media restraints to obliterate the over-dissected medial pockets.  It is harder to correct this type of symmastia when the implants are so large: the excess volume pulls the skin away and fights against the medial restraints.


Check with your surgeon to see if he/she has had experience correcting this. 

Symmastia Concerns?

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Thank you for the question and pictures.

The medial malposition of the breast implants that you mention is obvious in the pictures that you have posted.  The medial malposition of the breast implants cause the nipple/areola complexes to be off-center on the breast mounds.

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.

 As far as selecting a plastic surgeon to perform the procedure, you will have to do your due diligence and make sure that the surgeon you choose to perform the procedure can demonstrate successful  repairs of medially malpositioned  breast implants for patients in similar situations.

I hope this helps.

Not true symmastia

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I think that your implants are just too big for your frame. I would remove them and put in much smaller implants. But, I would wait until you are at least 3 months post op before doing anything.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Synmastia repair

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Repair of your synmastia will be unlikely to succeed unless you are willing to switch to smaller implants.  Though you could suture the capsule and reinforce this with an ADM, the volume of the implants relative to your chest size would place a great deal of tension on the repair and probably have it recurr.  At the current size of your implants, shifting them laterally will also give you too much fullness on the side of your chest (side boob), that also bothers patients.   

Leonard T. Yu, MD
Maui Plastic Surgeon

Symmastia/Revision Question

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I am not sure this would fit my understanding of the definition of symmastia, but I certainly do see and understand what you find unattractive about the outcome. Symmastia after breast augmentation usually implies that the implants have crossed the midline, and here there is still visible a separation between the two (middle picture), although that separation may not last too much longer. 

This is an unusual problem. Many surgeons have done thousands of breast augs and have never done a symmastia repair. Only in recent years has a good product (acellular dermal matrix) become available to help do a definitive correction. If your surgeon has no experience with symmastia correction and the use of ADM's, look elsewhere. 

I think the main causative factor is the size of the implants. Beginning with no breast tissue and using so large an implant is a a high risk factor for problems with not having enough room for an implant. If these did not encroach upon the midline, they would probably reach well beyond the chest wall. 

They are not centered behind the areolae, and that is why the nipples look too far lateral.


The solution is going to require repairing the medial attachments of the pectoral muscles to the sternum (symmastia repair), and using smaller implants that can be centered behind the areolae. With an smaller implant, the fold under the breast may also need to be buttressed so the the implant is not sitting too low. 

Thanks for the question, and best wishes. 

Thanks for the question, best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon


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I think based upon your photos that your implants are too big. If the implants are under the muscle, then I doubt that you have a true symmastia but stretching a bit centrally. Closing down the pocket medially and using smaller implants, likely will correct the problem.  An exam in person would be critical. Since it is relatively recent that you had surgery I would wait a few more months to fix it.

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

Symmastia correction

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Symmastia correction can be difficult - especially with large implants in place. I like to use Strattice for correction as it allows extra support to the treated areas. have done this with other transgender patients with large implants with great success. Only issue is timing of surgery. i would wait a few more months for the tissues to stretch a bit more before attempting correction.

Jason Pozner, MD
Boca Raton Plastic Surgeon
4.7 out of 5 stars 46 reviews

Symmastia repair

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I am not certain that this is a true symmastia, but your implants do appear to be encroaching upon the midline. I think that the biggest issue is the size of your implants.  Any attempts to try to move your implants laterally will likely fall short of being satisfactory unless smaller implants are used. Once this is done, the inner portion of the implant capsule can be closed to reduce the size of the capsular pocket. This can improve the narrowed space between the implants. I have not found that acellular dermal matrix (alloderm, strattice, etc.) is usually needed for this. 

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 87 reviews

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.