Synmastia or Just Really Close Cleavage? (photo)

I'm 6 weeks post op today.I went to my cosmetic surgeon (yes consmetic:( wish I had used a board certified PS now) yesterday because I was afraid that I may have symmastia.He says he doesnt think so then tells me hes never seen it in person only in books & internet.He then told me they are to close & I would need a revision surgery.I'm not sure he knows....Does this look like symmastia??I'm not sure if it is or if its just really close cleavage.I have a consult in person with a PS not CS on 15th

Doctor Answers 22


Hi.  From the photos, it does not appear to be true symmastia at this time, as the skin still appears correctly attached to the pre-sternal area.  Hopefully, it will stay attached!  Large implants, requesting tight cleavage, and pectus excavatum make this problem more likely - but it can usually be repaired surgically.

Get a consult from a local PS, as assessment from photos can be somewhat limited.


Orlando Plastic Surgeon
4.9 out of 5 stars 79 reviews


Your photos suggest that your implants are very close together but not true synmastia. The implants appear to be to large as well. Seeing a board certified plastic surgeon to discuss your options at this point is a good decision.

Todd C. Case, MD
Tucson Plastic Surgeon
4.9 out of 5 stars 55 reviews

Concerns about symmastia

Confused by all the answers? Your situation which is an incredibly common one should be a lesson to all those reading the answers provided by plastic surgeon experts. Though there is never any guarantee, when looking for a doctor to perform your cosmetic surgery (most), it would be very wise for your search to consider only plastic surgeons. Otherwise, it is buyer beware...

You don't have true symmastia yet but your implants are abnormally close and too large. You may very well develop this problem in the future. It may be prudent to seek a smaller implant size which may lower your risk of developing symmastia. Placing your implants in a submuscular pocket will also help address this issue.

See a board certified plastic surgeon!!

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 30 reviews

Breast augmentation -getting it right the first time

I would consider your posted photos symmastia and am very sorry you had to go through this. The implants are way too large for your body frame. In the bending over photo the right implant is so large it goes out past the edge of your body. The saddest thing is that you will have to remove the implants and start all over. You will be paying twice for something that should have been done once. The most important thing for you to do is pick an appropriate surgeon on the next round, make reasonable demands of him/her and do not ask for unreasonable results/unachievable goals.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

Symmastia vs. close cleavage

Thank you for your question and photographs. There is a very fine line between actual symmastia and just close cleavage. As you are just 6 weeks post-op, you may not have the final answer yet. It does look like your implants are positioned too close together and it may well be that you are on the verge of developing symmastia. You are doing the right thing by seeing a board certified plastic surgeon for an evaluation. You may benefit from having the outer portions of your pockets opened up to allow your implants to move more to the side so that the center of the implants are centered where your nipples are.

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 38 reviews

Yes, you have really close cleavage (which could be early symmastia).

Your implants are not centered beneath your nipples; they are medially displaced and would appear more natural if they were both slightly smaller, and more laterally positioned.

When you push your breasts together, if the skin above your breastbone pushes aways from the bony attachments, then this is symmastia. If the cleavage stays deep and attached, this is just "close" cleavage but could eventually develop into symmastia, particularly when you wear a bra that will naturally push your breasts together. Over time this worsens the central skin and tissue attachment stretch and can gradually close down the lateral pocket, giving you more severe symmastia and a "wall-eyed" nipple/areola look.

Surgical repair of this would require internal suture capsulorrhaphy to the chest wall on both sides, as well as external tape and bra support for many weeks. This may need more than one operation in rare cases.

You can have large implants if you wish, but the positioning should have been a bit better, and while your results are not bad, they may require re-operation at some point in the future. Good luck and best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Do I have symmastia?

You don't have symmastia in my opinion, and do not "need" a revision.  The shape of your ribs influences final implant position, and you may have a forme fruste of pectus excavatum based on one photo.  It is difficult to tell without exam.  Even with revision by implant replacement, capsulorrhaphy, and other maneuvers, the result you desire may be difficult or impossible to achieve.  Look at the positive:  You're a thin woman who has true "cleavage" without a bra, the dream of many!

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews

Narrow cleavage is different from symmastia.

Pre-operative assessment with photos and a current examination is needed to give you advice. Your breast implants are very close together, your tissue is thin and  your implants are too large for your chest. Even if there is still some tissue separating your breast contours (therefore not symmastia), you are very likely to develop problems as your tissues stretches and thins further.

Getting another opinion by a Plastic Surgeon is your best place to sort out your current diagnosis as well as your risks and options. If symmastia is confirmed then it is difficult to fix but at least you will be in more qualified hands.

Good luck.

Dr. Mosher

Mathew C. Mosher, MD
Vancouver Plastic Surgeon
4.5 out of 5 stars 34 reviews

Synmastia after Breast Augmentation

From the photos that you show us, we can see that your frame is fairly petite, and that the implants are probably too large and medially (towards the middle of the body) displaced. It may not be actual synmastia, as the skin overlying the sternum appears to by adherent to that bone, and not lifted off of it. Talk to your surgeon, and see if he/she has any suggestions. You may need to replace the implants with smaller ones, or perhaps adjust the pockets or the placement of the implants. The actual diagnosis or name of this condition more a matter of semantics, and is not as important as what to do next. Good luck and fare well.

Daniel Kaufman, MD, FACS
New York Plastic Surgeon
4.7 out of 5 stars 24 reviews


First, it is always helpful to see preop photos because some women with large natural breasts sometimes have this. But with implants, and jsut based on the photos, it looks like you have symmastia.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 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.