Symmastia is a very rare complication of breast augmentation, and one of the most difficult to correct. Also called uniboob, it is a specific example of a post-operative problem requiring a thorough evaluation and complex surgical techniques. This is one of the most feared complications following breast augmentation, and the correction of symmastia is one of the most difficult problems facing any plastic surgeon. Symmastia is present when one or both implants are positioned too close to the midline over the sternum, which is the bone in the midline of the chest. The perception that patients can have a surgical cleavage after breast augmentation is not totally accurate. Many times, the surgeon will attempt to recreate breast cleavage by dissecting the breast toward the midline. Particularly if you are under the muscle, the attachment of the muscle in the midline needs to be completely released. When this barrier is completely removed, implants can shift towards the midline; when the breast pockets, or capsules, surrounding the implants are too close together, both breasts become connected through the midline and you have essentially three boobs. There are different grades of symmastia; in the worst, the breasts have one capsule that is continuous from one breast to the other. In other words, the implants can both be squeezed into the other breast pocket. You can diagnose yourself by noticing that your breasts touch in the middle, the skin has lifted off of the breastbone, and there is no separation of the breasts at the midline. When you push your finger in the middle of your chest, your implants may separate but then spring back toward one another when you remove your finger. You may notice that the breasts have no separation.During surgery, proper implant position is crucial. The implant needs to be at the center of the nipple. Symmastia is an implant pocket problem, not an implant problem. In my experience the only true, long-term correction for symmastia is a revision surgery. I have had good results with creating a pocket between the capsule and the pectoralis muscle. The attachment of the capsule to the surrounding tissue allows the dissection of a surgical pocket that will result in an implant positional correction.