What is Symmastia?
When breast implants are too close together, it is called symmastia (or “uniboob.”) This can vary from implants being just a little too close together and tenting up the skin over the breastbone, to implants that are actually touching one another and creating a true uniboob. Sometimes the implants are equally malpositioned, and sometimes one may be in the proper position but the other may cross the center line of the body. It’s good to have cleavage, but with symmastia there is too much cleavage and the cleavage does not look normal or attractive.
Since too much of the breast implant volume is located between the nipples, the nipples are often tipped outward and the breasts can look very deformed. It is very frustrating to women because this is something that oftentimes cannot be hidden with a bra.
Many of the symmastia patients Dr. Teitelbaum sees in his Santa Monica office have inferior malposition (breast implant too low) in conjunction with it.
Four basic conditions contribute to the development of symmastia. The first is a depressed breastbone, which allows the implants to fall towards the center when a patient is on their back. In its severe form, a depressed breastbone is called pectus excavatum. This condition is not always symmetrical, so many symmastia patients are uneven. (This is the opposite of pectus carinatum patients, who have overly prominent breastbones, thereby causing their breast implants to be pushed out to the sides.)
The second situation is that the pocket was not accurately dissected. As careful as surgeons know to be when performing breast augmentations, sometimes a surgeon inadvertently makes the pockets too close together. When implants are placed behind the muscle, the muscle attachments on the side of the breastbone are to be left intact; but some surgeons intentionally divide them in an effort to put the implants closer together. This creates a big risk for the implants falling too close together. If an implant is placed in front of the muscle, then there is no natural anatomic boundary for the dissection, and so it is easier for a surgeon to mistakenly make the pockets too close together.
Some surgeons believe that making a big pocket and having patients massage their breasts is a good way to reduce capsular contracture. Though that has shown to be incorrect, some surgeons still do this. If the pocket is opened up too much towards the center then the implants can fall too close together.
The third contributing factor is implant size. The bigger the implant, the more pressure it will place on the surrounding tissue, which can tear or stretch with time. A great many patients have implants that are simply too large for them. They may be too wide for a patient’s rib cage and therefore are essentially forcing themselves towards the center. Or they can be so projecting that as they push the skin forward they tent the skin off of the breastbone.
The last factor is the strength of the patient’s tissues. Some patients have very thick, tight, and strong tissues. Some have thinner and more flexible tissues that are less able to withhold the pressure of an implant and are more susceptible to allowing the pocket to enlarge.
If a patient reports that symmastia existed immediately after surgery, there is a suggestion that the problem was the pocket being made too large. If the symmastia developed later, it probably means that the pocket enlarged by pressure, which would be some combination of implant size and weight, the shape of the rib cage, and the strength of the tissues.
Can Symmastia be fixed?
Los Angeles symmastia treatment surgeon, Dr. Steven Teitelbaum, is an expert in breast revision surgery in general, and symmastia in particular. He has treated patients from all around Santa Monica, Los Angeles, Beverly Hills, and even from overseas. He has written an original article on treating symmastia in the most important plastic surgery journal, has published a book chapter teaching surgeons how to do it, and has taught a course on it at the biggest plastic surgery meeting.
There are a variety of techniques for treating symmastia, and no one technique works for all patients. With his experience and expertise in all of the various methods, he can give you your best chance at getting your symmastia corrected. One technique closes off the unwanted portion of the pocket in which the implant sits (“the capsule”) with special stitches; this is called a “capsulorraphy.” The method also depends upon whether the implants were in front of the muscle or behind the muscle.
Another technique is the “neosubpectoral pocket” or “neosubglandular pocket”. This is a new technique which Dr. Teitelbaum has written about and taught to other surgeons, and it is based upon using the body’s own tissues to close off the pocket. If there is an instance when tissue is weak, Dr. Teitelbaum can reinforce it with an acellular dermal matrix (ADM), such as Alloderm® or Strattice, or it can involve the use of a mesh such as Seri Scaffolding or Galaflex. A critical component for many patients is accepting a smaller implant. The best repair in the world cannot hold up against a significant amount of pressure from a large implant. This is something that Dr. Teitelbaum will discuss with you at length in his Santa Monica office during your symmastia consultation.