One of the oddest breast augmentation complications is symmastia, meaning literally, “one breast.” Referred to by patients as “unibreast” and “uniboob,” symmastia is also, thankfully, a very rare complication of breast augmentation. Nevertheless, if you’re considering breast implant surgery, you’ll want to know about all the possible poor outcomes including this one. Full knowledge helps in making the right decisions with your plastic surgeon.
What is it?
If you search the Web for the term, “symmastia,” (sometimes “synmastia”) you’ll find photos of what the condition looks like: implants that meet in the middle of the cleavage. Cases vary from slight to severe. In slight cases the implants barely touch across the cleavage; some call this “kissing implants.” In other patients, there’s not much valley between the breasts at all. These women are unlucky enough to look like they have a loaf of bread with rounded ends across their chest, giving rise to another nickname for the condition: “breadloafing.”
When Does It Happen?
Symmastia occurs when the skin and tissue in between the breast implants, in the cleavage, pulls up and off the breastbone (sternum), allowing the implants to move together. Sometimes the condition is noticeable soon after surgery. In other cases, symmastia shows up later. It can and often does worsen with time.
Patients who are worried that symmastia is starting to occur after surgery should see their doctor right away. The condition is best treated sooner rather than later.
Why Does It Happen?
Positioning and creating the breast implant pocket is one of the most critical steps in successful breast enlargement surgery. In many cases, the plastic surgeon simply over-dissects the pocket, creeping closer to the center of the chest than advisable. Sometimes the doctor is trying to create the dramatic cleavage the patient has requested, in other cases it can be just a mistake of cutting too far.
Occasionally a patient will contribute to the condition by being careless during her recovery. Women should handle their breasts gently after surgery, avoiding vigorous massage and push-up bras for a time.
Who is Most Likely to Experience It?
Patients with a higher risk of symmastia include women who are petite in frame, especially those who want large implants. Women who are very thin, with little tissue covering the sternum, may also run a higher risk of symmastia.
Some people have a rib cage that dives down toward the center of the torso toward a depressed breastbone. This condition, called “pectus excavatum,” can also lend itself to a higher risk symmastia.
How is It Treated?
Most plastic surgeons agree that symmastia is difficult to correct. Once skin and underlying tissues no longer adhere to the breastbone, it’s challenging to re-create space between the breasts. Some doctors attempt this externally but many times this method doesn’t work.
There are several possible approaches to revision surgery. Some plastic surgeons favor re-attaching skin and tissue internally using sutures and sometimes a patch material. A two-stage process may be required for this, allowing several months of healing time before replacing implants. The plastic surgeon may enlarge the implant pocket toward the outer edge of the torso and recommend smaller implants the second time around.
Other surgeons prefer to perform revision surgery creating a new pocket for implants above or below the muscle (opposite the previous positioning), thereby avoiding the reuse of the old breast pockets that ended up tunneling across the sternum.
No two cases of symmastia are alike, and the surgical plan to correct the condition must be carefully thought out. Patients should visit their original surgeon to discuss revision and seek out at least one other opinion before deciding on a course of action. It’s also a good idea to work with a plastic surgeon with at least several successful revisions and to see photographic evidence.
Again, symmastia is not a risk to be overly concerned about. If you’re considering breast augmentation surgery, symmastia doesn’t need to deter you. As with any risk of any surgery, your strategy should be: learn about it, ask about it, take steps to prevent it and proceed with what’s best for you and your quality of life.