Symmastia is a condition wherein there is a lack of separation between breasts. This condition can be congenital, and it can also be caused by the use of breast implants. To make sure that you really have symmastia due to breast implants, you can test it by pressing the skin in the middle of your chest towards your sternum. If it lifts back up after you remove your fingers then it is likely that you have symmastia and should seek help. Symmastia is caused by several things such as the use of a very large implant, subglandular positioning of the implant, and over-dissection of the pocket. Most of the time, it is caused by a surgical error on the part of the surgeon. The occurrence of symmastia is rare, but when it happens, it can be devastating for the patient because the only remedy is to undergo another surgery to correct it. While some surgeons suggest the use of external sutures, only internal sutures through a revision surgery will be successful in repairing it. After the revision surgery, patients should use a special kind of bra in order to support the sutured muscles on the sternum. Physical activity would also be limited to prevent the muscle from exerting too much effort. As oft said, an ounce of prevention is worth a pound of cure. To avoid troublesome complications like symmastia, carefully choose a well-experienced, board certified and knowledgeable surgeon. What is Symmastia? Symmastia is described as having one breast instead of two separate ones. This can be a congenital anomaly, but its occurrence is very rare. In this condition, the soft tissues of the breast connect at the midline. In order to correct this, plastic surgery is needed. On the other hand, symmastia can also refer to the condition wherein patients who undergo breast implant surgery end up having breasts that appears to be connected together in the middle of the chest. This can happen when the implants are positioned too close to each other and to the breastbone. Some people may feel a discomfort on their midline when this happens. To test whether you really have symmastia, you can look at the mirror and see if the separation between your breasts is gone. You will see that the skin looks like it is lifted off your sternum because of the protrusion of the two breasts. Try to push that area with your fingers and then let go. It is possible that the skin will be pushed back but will spring up after you remove your fingers. You can also take a look at your nipples. Normally, the nipple should be found in the center of the breast implant. When you have symmastia, the nipples appear to be pointing outwards and bizarrely off center. Causes Of Symmastia The symmastia or uniboob can occur in women right after the implant surgery is done or in a few months or years after the surgery. The occurrence of symmastia happens due to a variety of factors. Surgical error due to an inexperienced surgeon is one of the common reasons why symmastia can happen. There is a possibility that the pocket for the implant was overly dissected that it already reached or came much too near the midline of the chest. The surgeon may have overly dissected the pocket because they wanted to create more cleavage. Symmastia can also happen due to the enormous size of the implants. If the surgeon inserts implants that are too big for the patient’s condition, there is a great chance that a uniboob will form. Also, since a larger pocket requires more dissection of the muscles, this could lead to symmastia. It would be advisable to switch to smaller implants that will be more suitable to the anatomy of the patient, but simply switching to smaller implants doesn’t remedy the problem. Therefore, it is imperative that one should make sure to choose the correct size to prevent symmastia. Those who have undergone multiple breast augmentation surgeries are also more likely to develop symmastia. Additionally, when the implants are placed above the muscle or in the sub glandular position, there is also a chance for the skin and breast tissue to stretch over time. This is why the symmastia would only appear after months or years after the surgery. The symmastia that occurs right after the breast implant surgery are likely due to a surgical error, whereas those that only develop over time may be due to other reasons. Nevertheless, finding a solution is necessary to improve the patient’s condition and to relieve the pain or discomfort it causes. Surgical revision may be the only solution. Revision Surgery For Symmastia Due to the mild discomfort and the weird appearance symmastia causes, most have it repaired. The best and the only successful way to do it is to undergo revision surgery. Those who have subglandular implants need to undergo surgery to move their implants into the submuscular position. In this process, a new pocket will have to be carefully made. For those who have implants that are already under the muscles, a few options are available. The first option is to move the implants above the muscle into the subglandular position. Another option is to keep it in the submuscular region, but repair the cleavage area by suturing the muscle and tissues to the sternum while the implant capsule acts as an anchor. For others who don’t want to use the implant capsule as an anchor, other soft tissue grafts can be used. Although soft tissue grafts are known to be durable, they are quite expensive. Unfortunately, symmastia cannot be successfully repaired through non-surgical methods. It is possible to use a separator bra to separate the breast temporarily, but this is not a permanent solution. Some surgeons might suggest external suturing, but this would only lead to the formation of more visible scars and there is no guarantee that it will work. Consequently, a surgical procedure that fixes the pocket of the implant would be best. Even if you choose to have smaller implants, there will still be a need to repair the pocket by using internal sutures. When the pockets are successfully fixed, the smaller breast implants can now be placed. Nevertheless, it is also possible for those who have symmastia to switch to bigger implants if they wish to do so. In the revision surgery, new bigger implants can be used, but the repair of the pocket should first be dealt with. In the revision surgery, it is possible to maintain the size of the implants, reduce it, or increase it, so long as they fix the condition first. Recovery From Revision Surgery After the revision surgery patients will be required to wear a special bra, or what is known as the “thong” bra. This bra helps through the recovery process by giving support to the cleavage and putting pressure on the cleavage area. This promotes healing of the internal sutures made. Most patients will also be strongly advised to restrict physical activity in order to heal properly from the revision surgery. It is important that the muscles in that area are not over exerted to ensure that it wouldn’t rise from the sternum once more. If the muscles lift off from the sternum again, there will be a need to undergo another surgery for the internal sutures. How to Avoid Symmastia In order to avoid or lessen the risk of the occurrence of symmastia, you should carefully choose your surgeons well. An inexperienced surgeon is most likely to do breast implant surgeries that lead to symmastia. Experienced surgeons know the right size of implants that should be used depending on your body type. If a patient chooses to go for bigger implants, surgeons would explain that there is a chance for them to get a uniboob. In this way, the patient is well informed and it is up to them to decide whether it is worth the risk to get larger implants in order to have more voluptuous breasts. Conclusion Symmastia is a rare congenital condition wherein the breasts have no separation. It can also happen after a breast augmentation surgery in which implants are used. When the implants appear to be too close to each other or when the skin and muscle lift because of the pressure of the large implants, symmastia occurs. The causes of symmastia include having too large implants that are disproportionate to the patient’s body, having the pocket over-dissected to create cleavage or due to surgical error, and the use of subglandular placement of the implants. In order to repair the symmastia, a patient has to undergo revision surgery. The pockets are repaired and the muscles will be sutured back to the sternum. Transferring the implants to the submuscular position is also a solution if the implants were originally placed in the subglandular position. After the repair, patients are required to wear a special kind of bra that will help support the sutured muscle. In order to prevent having symmastia, you must choose the most qualified and experienced surgeon. Most of the time symmastia is due to the surgeon’s surgical error so it would be best to choose wisely to prevent mistakes.