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Symmastia (sometimes spelled symastia), also called "uniboob" or "breadloafing", occurs when breast implants sit too close together, causing the breasts to appear connected across the midline. The skin lifts off the breastbone, creating one continuous breast contour instead of two distinct breasts. This complication affects roughly 1-2% of breast augmentation patients and almost always requires surgical correction.
The underlying problem is simple: the implant pocket extends too far toward the center of the chest. When this happens on both sides, the pockets can merge or overlap, eliminating the natural valley between the breasts.
What Causes Breast Implant Symmastia?
Surgical Technique Issues
The most common cause is misjudging where to stop the inner edge of the implant pocket during surgery. If the surgeon dissects too far toward the midline, the pocket can merge with the opposite side. This is why choosing an experienced surgeon matters—proper pocket creation requires precise anatomical knowledge and surgical restraint.
How the pocket is dissected matters too. Damaging the fascia—the tissue layer covering the chest muscle—during dissection weakens the natural barriers that keep the breasts separate.
Placing implants over the muscle (subglandular placement) increases symmastia risk. The pectoral muscle naturally attaches to the outer edge of your breastbone, providing a protective barrier. When implants go under the muscle, this attachment helps prevent the pockets from merging.
Implant Size and Body Frame Mismatch
Every patient has an upper limit to the implant width their frame can accommodate. When the implant is too wide for the chest, the pocket must extend dangerously close to the midline. Large implants also exert more pressure on the central chest tissues, potentially tearing the skin and muscle attachments loose from the breastbone.
Anatomical Risk Factors
A narrow sternum provides less surface area for strong tissue attachments, increasing symmastia risk. Patients with pectus excavatum (sunken chest) face even higher risk because their anatomy naturally brings the breasts closer together.
Poor tissue quality from aging, genetics, or nutritional deficiencies can weaken the connective tissues that normally keep the skin attached to the chest wall.
Post-Surgical Factors
Aggressive implant massage can tear delicate healing tissues, potentially creating symmastia. Similarly, poorly fitted compression garments or overly tight surgical dressings can push implants toward each other during the critical healing period.
Symmastia Repair Options
Non-Surgical Treatment
If caught immediately after surgery, mild symmastia can sometimes be corrected with specialized compression therapy. A custom bra pushes the cleavage skin against the breastbone, encouraging it to reattach. This only works in the first few weeks after surgery and succeeds in less than half of cases.
Surgical Correction
Most symmastias require surgical repair. The goal is always the same—close off the excess inner pocket—but the techniques vary. This isn't a simple implant exchange; it is reconstructive surgery that rebuilds the tissue plane between the breasts and restores normal anatomy, not just separates the implants.
Capsulorrhaphy is the most common approach. After temporarily removing one or both implants, the surgeon uses internal sutures to close the opening over the sternum. The implants are then repositioned in the corrected pockets.
Mesh reinforcement adds synthetic material to strengthen the repair, sometimes called an "internal bra." We avoid mesh when possible because it's expensive, doesn't necessarily improve outcomes, and introduces its own complications.
Neopocket reconstruction uses the patient's own scar tissue (capsule) to create an internal barrier. This technique offers more precision and reliability than simple suture repair. We prefer this method whenever anatomically possible.
For severe or recurrent cases, temporary implant removal may be necessary. This allows complete pocket closure without implant pressure interfering with healing. New implants—often smaller ones—can be placed 3-6 months later.
Even when the implants stay in, replacing them is often part of the repair. The current implants may be too large or the wrong shape for the corrected anatomy, and switching to implants with appropriate dimensions helps the correction hold.
Recovery After Symmastia Repair
Recovery from symmastia correction takes longer than recovery from a primary breast augmentation. You'll need to avoid activities that stress the chest muscles for at least six weeks so the internal repair can heal.
Swelling and discomfort are normal during the first two weeks. The final result won't be apparent until three to six months after surgery, once the tissues settle and the swelling resolves.
Most patients see a clear improvement in breast separation, but some central fullness may persist, especially in patients with very narrow chest walls or severe symmastia.
Risks of Symmastia Surgery
Like any surgical procedure, symmastia repair carries standard risks including bleeding, infection, and scarring. However, the most concerning risk is recurrence.
Symmastia repair has one of the highest failure rates in plastic surgery. Even when performed expertly, the repair can fail because the forces that created the original problem—implant weight, tissue weakness, anatomical constraints—remain present. Recurrence is more likely when the new implants are still too large for the chest or when post-operative restrictions aren't followed.
This is why some surgeons recommend permanently downsizing to smaller implants as part of the repair strategy.
Preventing Symmastia
Prevention starts with surgeon selection. Choose a board-certified plastic surgeon with extensive breast revision experience, not just breast augmentation experience. Revision surgery requires different skills and judgment. If you already have symmastia, ask a prospective surgeon to show you before-and-after photos of symmastia corrections and to explain the specific techniques they plan to use.
Be realistic about implant sizing. If you have a narrow chest or want very large implants, discuss symmastia risk openly with your surgeon. Sometimes the size you want simply isn't compatible with your anatomy.
At a consultation for primary augmentation, ask how your chest wall measurements influence implant selection. A thorough surgeon will measure your chest width and explain why certain implant sizes won't work for you. A surgeon who promises any cup size regardless of your starting anatomy is a red flag; good results come from working with your natural proportions.
Consider submuscular placement, especially if you have risk factors like a narrow sternum or thin chest wall tissues.
Cost of Symmastia Correction
Symmastia repair typically costs $8,000 to $15,000, depending on the complexity and whether one or both breasts require treatment. This includes surgeon fees, anesthesia, facility costs, and follow-up care.
Complex cases may require staged procedures, increasing the total cost. Some patients need implant removal, tissue healing time, and then implant replacement as separate surgeries.
While revision surgery is never ideal, symmastia is too significant a deformity to leave untreated. The psychological impact of losing the natural breast separation can be profound, making surgical correction worthwhile despite the challenges involved.
The key is choosing a surgeon who understands both the technical complexity and the high stakes involved in symmastia repair.
Frequently Asked Questions
Can symmastia fix itself over time?
No, symmastia does not resolve on its own. The structural problem that allows the implants to merge will persist without surgical intervention. Early cases might respond to compression therapy, but established symmastia requires surgery.
How long after breast augmentation can symmastia develop?
Symmastia can appear immediately after surgery or develop gradually over several months as tissues stretch and settle. Most cases become apparent within the first 6-12 weeks after surgery.
Will insurance cover symmastia repair?
Insurance typically does not cover symmastia repair since it's considered a complication of elective cosmetic surgery. However, coverage policies vary, and some plans may provide partial coverage in exceptional circumstances.
If you're dealing with symmastia or concerned about implant complications, schedule a consultation to discuss your options. Dr. Schwartz has extensive experience with complex breast revisions and can help determine the best approach for your specific situation.
See also: double bubble after breast augmentation: what causes it and how to fix it.
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Questions about this procedure? Dr. Schwartz will give you a direct, honest answer at your consultation.
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