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Symmastia or Tenting? (photos)

Not sure what is going on here but it feels and looks as if my breasts are shifting together. When I lay down and generally when sitting or standing the skin in between my breasts have formed a little bubble? I can't feel my chest in between my breasts anymore? My friends have began to notice and have made comments - I'm seeing my surgeon as soon as he could fit me in (few weeks from now) so I wanted to have some sort of guidance now.

Doctor Answers 9

Symmastia or Tenting?

May 25th, 2016
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Thank you for your question and photographs.  Because your middle picture appears to demonstrate a well-demarcated separation between your breasts it does not appear that you have synmastia.  You have skin tenting that should resolve, depending on how long it has been since your surgery.  Ultimately talk to your surgeon as only an in-person examination can confirm the synmastia.  Hope this helps.

Web reference: http://www.nelson-center.com/breast-augmentation.html

Nelson Castillo, MD
May 25th, 2016

Symmastia or Tenting?

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Thank you for your question and photographs.  Because your middle picture appears to demonstrate a well-demarcated separation between your breasts it does not appear that you have synmastia.  You have skin tenting that should resolve, depending on how long it has been since your surgery.  Ultimately talk to your surgeon as only an in-person examination can confirm the synmastia.  Hope this helps.

Learn more: http://www.nelson-center.com/breast-augmentation.html

Nelson Castillo, MD

Disagree

May 25th, 2016
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Some of the responses have indicated that they think you have symmastia. It is impossible to make that diagnosis without having more information--preop pics, size of implants, how long ago was your surgery, etc.

Go see your surgeon and have him/her evaluate you further. Everything else is pure speculation.

Best.
Kirk Moore, MD
May 25th, 2016

Disagree

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Some of the responses have indicated that they think you have symmastia. It is impossible to make that diagnosis without having more information--preop pics, size of implants, how long ago was your surgery, etc.

Go see your surgeon and have him/her evaluate you further. Everything else is pure speculation.

Best.
Kirk Moore, MD

Tenting

May 25th, 2016
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It looks more like tenting rather than a true symmastia because it appears that there is a defined separation between the two breasts.  The tenting may improve as the swelling subsides.

Web reference: https://www.stevenwallachmd.com/breast-procedures/breast-augmentation-new-york/

Steven Wallach, MD
May 25th, 2016

Tenting

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It looks more like tenting rather than a true symmastia because it appears that there is a defined separation between the two breasts.  The tenting may improve as the swelling subsides.

Learn more: https://www.stevenwallachmd.com/breast-procedures/breast-augmentation-new-york/

Steven Wallach, MD

Synmastia

May 25th, 2016
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Hello,

Thank you for your question and photos. If you notice that the space between your breasts has disappeared following your breast augmentation or the skin in the area is raised to a certain extent, then you have developed symmastia (a condition that can also exist congenitally).

Unfortunately without a physical exam it won't be possible to determine what you are experiencing. It does appear that you have tenting which, depending on your stage in recovery, could be expected to resolve somewhat. However, your Plastic Surgeon must examine you physically to rule out the issue of Synmastia.

All the best

Web reference: https://edelsteincosmetic.com/learning-centre/symmastia/

Jerome Edelstein, MD
May 25th, 2016

Synmastia

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hello,

Thank you for your question and photos. If you notice that the space between your breasts has disappeared following your breast augmentation or the skin in the area is raised to a certain extent, then you have developed symmastia (a condition that can also exist congenitally).

Unfortunately without a physical exam it won't be possible to determine what you are experiencing. It does appear that you have tenting which, depending on your stage in recovery, could be expected to resolve somewhat. However, your Plastic Surgeon must examine you physically to rule out the issue of Synmastia.

All the best

Learn more: https://edelsteincosmetic.com/learning-centre/symmastia/

Jerome Edelstein, MD

Symmastia or Tenting?

May 24th, 2016
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I am sorry to hear about the problem you are experiencing.  Although the diagnosis would require in person evaluation, in my opinion, it is most likely that you do not have symmastia, in that the breast implants do not cross or communicate across the mid line. However, you do have breast implant displacement medially.  Certainly some skin tenting is present as well.

This can be corrected using internal suture techniques (capsulorraphy) and probable reverse capsulotomy ( opening of the breast implant pockets to the sides).  Sometimes, the use of additional supportive material such as acellular dermal matrix is helpful (in supporting the capsule repair) as well.  The revisionary breast surgery will also serve to better center the nipple/areola complexes on the breast mounds.
You may find attached link helpful to you as you learn more about options available.
Best wishes.

Web reference: http://www.poustiplasticsurgery.com/Procedures/Procedure_symmastia.htm

Tom J. Pousti, MD, FACS
May 24th, 2016

Symmastia or Tenting?

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I am sorry to hear about the problem you are experiencing.  Although the diagnosis would require in person evaluation, in my opinion, it is most likely that you do not have symmastia, in that the breast implants do not cross or communicate across the mid line. However, you do have breast implant displacement medially.  Certainly some skin tenting is present as well.

This can be corrected using internal suture techniques (capsulorraphy) and probable reverse capsulotomy ( opening of the breast implant pockets to the sides).  Sometimes, the use of additional supportive material such as acellular dermal matrix is helpful (in supporting the capsule repair) as well.  The revisionary breast surgery will also serve to better center the nipple/areola complexes on the breast mounds.
You may find attached link helpful to you as you learn more about options available.
Best wishes.

Learn more: http://www.poustiplasticsurgery.com/Procedures/Procedure_symmastia.htm

Tom J. Pousti, MD, FACS

Tenting vs Symmastia

May 24th, 2016
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Thanks for the pictures but its really not clear which one you have.  Sometime the 2 things can look similar. In your situation, I think a physical exam would help determine if the left and right breast pockets/capsules are connected in the middle.  Good luck on the appointment with your surgeon in a few weeks.
Khashayar Mohebali, MD, FACS
May 24th, 2016

Tenting vs Symmastia

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thanks for the pictures but its really not clear which one you have.  Sometime the 2 things can look similar. In your situation, I think a physical exam would help determine if the left and right breast pockets/capsules are connected in the middle.  Good luck on the appointment with your surgeon in a few weeks.
Khashayar Mohebali, MD, FACS

Symmastia or Tenting?

May 24th, 2016
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Thank you for your question and photos.  One can not diagnose based on photos alone.  I would recommend seeing your surgeon for an in person examination and evaluation.  Good luck.
David J. Wages, MD
May 24th, 2016

Symmastia or Tenting?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question and photos.  One can not diagnose based on photos alone.  I would recommend seeing your surgeon for an in person examination and evaluation.  Good luck.
David J. Wages, MD

Symmastia

May 24th, 2016
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I agree with my friend Dr. Salzman below.  You have symmastia.  The question is how much it bothers as corrections of this imperfection can be costly and difficult.
Best Wishes,
Nana Mizuguchi, MD
Nana N. Mizuguchi, MD, FACS
May 24th, 2016

Symmastia

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I agree with my friend Dr. Salzman below.  You have symmastia.  The question is how much it bothers as corrections of this imperfection can be costly and difficult.
Best Wishes,
Nana Mizuguchi, MD
Nana N. Mizuguchi, MD, FACS

Do I have synmastia?

May 24th, 2016
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 From your photographs and description I would be suspicious that you have synmastia. Synmastia is when the two breast pockets made for the implants connect to each other. This will produce a tunnel connecting the two implants across the chest wall that is sometimes noticeable as skin pulling away from the breastbone. It is best diagnosed in person by squeezing on one side and seeing if the implant passes through this tunnel towards the opposite side. It seems to be more common when implants are placed on top of the muscle rather than below because, the muscle coming off the ribs, is further away from where the breastbone starts. When some attempt at making a wide breast space narrower is made, this may result in the pockets being very close to each other, such that with time and the pressure of the underlying implant, a tunnel is created between the pockets. In my experience, attempts to repair this with simple suturing techniques have failed. I've seen many a patient after these attempts with little depressions in the skin that are very hard to correct. The best correction involves either making a new pocket under the muscle and on top of the old capsule or creating a flap of breast capsule and suturing it to a piece of non stretchable material such as pigskin that we call Strattice. I would recommend that you go back to your operating surgeon to discuss these possibilities based on his or her examination. Good luck.

Web reference: https://www.itbecomesyou.com/breast-augmentation-louisville/

Marc J. Salzman, MD, FACS
May 24th, 2016

Do I have synmastia?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
 From your photographs and description I would be suspicious that you have synmastia. Synmastia is when the two breast pockets made for the implants connect to each other. This will produce a tunnel connecting the two implants across the chest wall that is sometimes noticeable as skin pulling away from the breastbone. It is best diagnosed in person by squeezing on one side and seeing if the implant passes through this tunnel towards the opposite side. It seems to be more common when implants are placed on top of the muscle rather than below because, the muscle coming off the ribs, is further away from where the breastbone starts. When some attempt at making a wide breast space narrower is made, this may result in the pockets being very close to each other, such that with time and the pressure of the underlying implant, a tunnel is created between the pockets. In my experience, attempts to repair this with simple suturing techniques have failed. I've seen many a patient after these attempts with little depressions in the skin that are very hard to correct. The best correction involves either making a new pocket under the muscle and on top of the old capsule or creating a flap of breast capsule and suturing it to a piece of non stretchable material such as pigskin that we call Strattice. I would recommend that you go back to your operating surgeon to discuss these possibilities based on his or her examination. Good luck.

Learn more: https://www.itbecomesyou.com/breast-augmentation-louisville/

Marc J. Salzman, MD, FACS

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.