Distance between breasts and symmastia Introduction How many women have worn at least one push-up bra to get their breasts closer together and get that perfect Hollywood cleavage? And how many of them haven’t crossed their arms together, hoping for a wonder bra? The perfect and wonderful cleavage that we see in media is that of perfect breasts pushed together by fullness and perfection. But it’s only an image. Some of us might be lucky enough to have great natural breasts and be able to get that look, but for most, this just doesn’t happen. There are many women who think that going through a breast augmentation surgery will give them that exact cleavage of full breasts. For them, this is the main reason for choosing to undergo this surgery. But little do they know that there are women who have their breasts too close together as if they were just one boob, and this is one of the risks when undergoing plastic surgery to bring breasts closer together. What is symmastia? This is a medical condition commonly known as the “uniboob,” and in the medical world it is known as symmastia. Symmastia might be a congenital condition, meaning that a woman can be born with this unusual breast appearance. But in most cases, it is a side effect of a breast augmentation surgery, an effect due to a doctor’s lack of skill or experience or due to some issues that the patient has with the tissues. Symmastia is the confluence of the tissue of both breasts across the midline of the sternum. Many women are not happy with the fact that their breasts are too far away from each other and think that getting implants will change this. The distance between breasts is not due to their size. The bigger they are the shorter the distance, as many people think. Anatomically, this distance between breasts is given by the width of your chest. If your chest is naturally wide, then your breasts will never be closer together than they already are. No implant will be able to change your anatomy. Another factor is the natural distance between your breasts: meaning that if they are originally placed far from one another, the implants will make them fuller, but it will not draw them closer. So, when you enter the plastic surgeon’s office, you need to keep this in mind: no implant will be able to change the distance between your breasts. What causes symmastia? During the operation, the surgeon will first make an incision, and then he will separate the breast tissue from the muscles and tissues of your chest, thus creating a pocket in which he will insert the implants. This pocket will be either in front or behind the pectoral muscle. During this step, he will need to cut through the tissue to make space for the implant. Getting the pocket to just the right size and position is essential for the success of your procedure. Otherwise the pockets will not be able to support the implants that will move forward. Being part of your body now, the implants will be followed by your breast tissues that will all slope forward and start healing in the middle of your chest, creating an unusual look and feel. Another factor that might cause symmastia is the size of the implant. Imagine you want to fit a melon in your sweater pocket. Not only will it never fit, but if you force it through, the pocket will break and the melon will fall. The same thing happens with implants. If your doctor does not have the necessary experience or knowledge to be able to explain to you that your body type is not suited for a big size breast implant, then this will happen. The tissues of the breasts will break, not being able to support such weight. The implants will slide, and the healing will be mistakenly done in the middle of your chest, creating something you would never want. It is said that symmastia often occurs in slender women because they would like to jump two or three cup sizes when getting implants. It is nice to be thin, but many thin women do suffer from image issues due to their breast size. Being small and thin, they also have small breasts. So, when they go to a plastic surgeon that tells them they will have the breasts of their dreams, that is it. Most do not even think of asking for a second opinion because this promise will solve all their image issues. But you need to keep in mind that because you are thin, you have probably not been able to carry too much weight with your hands until now, so what makes you think your body will be able to carry a breast that is thrice the size you have now? There is a congenital condition found in some called pectus excavatum. This condition determines an unusual appearance of the collarbone and the chest looks sunken, due to the abnormal growth of the sternum and ribcage. Women who have this condition will be more prone to developing symmastia than those who do not have it. This condition puts more pressure on the tissues due to the abnormal growth of the above-mentioned bones, and this usually makes the implants slope inward. If you know you suffer from pectus excavatum, you will need to find a surgeon that specializes in implant surgeries for women who have deformities in the chest wall area. Women with this specific condition are advised not to get implants at all or choose smaller ones. What is the treatment for symmastia? You might notice the symmastia immediately after the operation or only after a few weeks. At first, your breasts will be swollen and closer together. In time the swelling will go down and the implants will drop, so your breasts should have the usual gap between them. If you notice that there is no space between them, they are linked together by skin or fat or tissue in an abnormal way then, unfortunately, you have developed symmastia. Symmastia is not a disease or a medical condition that poses any threat to your health. It does not hurt, and it doesn’t affect your body in any way. It will most certainly affect you mentally since the whole purpose of an elective surgery is to look better and be happier with your body and image. There is a way to correct this issue; unfortunately, this requires a new surgery or, in some cases, multiple ones. There is no other way to correct this, or if you do not want to go through a new operation, then you will probably not be able to show your cleavage, which probably has been the whole purpose of you going to a surgeon in the first place. If you decide you need to correct your symmastia, then you should do it the minute you decide. The longer it passes from the first surgery, the more difficult it will be to correct it. The corrective surgery will have to take into consideration many factors such as the implant size, position, shape, your breast position, and the healing process of your inner tissues. Depending on all these factors, the surgeon will decide the best method he needs to repair the issue. The surgeon will need to remove the scar tissue from the breast pockets. To prevent the appearance of the same issue, most surgeons will do some internal sutures of the breast pockets. In this way, they will seal the pockets and prevent the implants from sliding inward towards the sternum. They will have to reposition the implants and hold them in place inside the pockets. Or, in some cases, they will need to change the implants altogether. This is usually the case when the cause of symmastia is the previous use of larger implants, not suited to the anatomical shape and figure of the patient. In this case, the surgeon will need to change the implants to smaller ones. Sometimes the breast pockets get smaller due to the sutures and, this is also a case when the doctor needs to change implants to smaller ones. The surgeon might also need to change the shape of the implants or position them above or below the pectoral muscle, depending on the original operation. In some cases, new breast pockets must be made to correct and further prevent the reappearance of symmastia. After the operation, you will need to wear a special symmastia thong bra and a rolled elastic bandage to keep constant pressure on the sternum area during the healing process. Conclusion The good news with symmastia is that it is still a rare condition. Most people will not develop this condition, but you need to be aware that this might always be a possibility and take the necessary steps to prevent it. The most important of all is choosing a good, certified and experienced plastic surgeon. Read, ask, talk, and question until you get all the answers and you feel comfortable to let that person use a knife on you. Don’t get excited by promises of great, superb looks and be rather happy with someone that contradicts your wishes and shows you reasons to be realistic. You CAN change your looks, but they need to be suited to the whole you!