Symmastia is one of the rarer, but more expensive and difficult complications to repair. It has many different names including synmastia, breadloafing, kissing breast implants, and uniboob.
Basically, when symmastia occurs, the implants meet in the middle of the chest. There is no separation between the implants, hence the name "kissing implants." The skin literally lifts off of the sternum/breast bone. In cases where implants are beneath the muscle, not only does the skin lift, the pectoral muscle also lifts away from the sternum. It causes pain and discomfort, along with the obvious distortion of the breasts, which can only be disguised with clothing that does not show cleavage.
In breast implants placed beneath the muscle, over-dissection of the pectoral muscle in the middle of the chest is almost always the cause. Over-dissection may be done in an attempt by the surgeon to create more cleavage, insert a larger breast implant, or it is simply accidental.
It can occur when the medial pectoral muscle (where it meets in the middle of the chest, at the sternum) is over dissected in hopes of creating closer cleavage, or in an attempt to insert a breast implant that is fairly large. The picture to the left shows a subject prior to breast augmentation surgery, which resulted in symmastia.
Symmastia can also occur in women with breast implants placed above the muscle in the subglandular position. In this case, the cause can either be surgical error, or it can be due to the stretching of the skin and breast tissues over time. In the case of the latter, symmastia can occur much later down the road. If symmastia occurs a short time after surgery, usually within a period of days to months, it is usually due to surgical error.
This photo depicts the patient in the previous photo after her breast augmentation surgery. She received 450cc McGhan saline breast implants. As you can see in the picture, her implants are close together, as there is very little space between them. At this point, as little as one week out, she was concerned about her cleavage being so close together. There was less than a 1/2" of space in between the breast implants, and symmastia was a definite concern.
By two weeks post-op, her cleavage was no longer just "close", it had completely lifted off of her sternum.
This photo depicts full-blown symmastia. Note that this does not occur literally overnight. It occurs gradually, although "gradual" can mean within a span of weeks or less, depending on how the pocket is dissected. This particular case of symmastia was severe. It depicts a "worst case scenario." This subject eventually went to another plastic surgeon to have her symmastia repair done.
Her 450cc breast implants, which her new surgeon told her were much too large for her frame, were replaced with 300cc saline breast implants.
If the implants are placed above the muscle, a symmastia repair usually involves moving the breast implants into the submuscular position. This creates a whole new pocket for the breast implant.
In cases of symmastia where breast implants are placed beneath the muscle, there are a couple of options. The first is to move the breast implants into the subglandular position. The second is to keep the breast implants in the submuscular position while at the same time repairing the cleavage area. In the latter, case, a portion of the breast implant capsule is used as an anchor so that the muscles and tissues can be sutured to the sternum. In other cases, the capsule is not used, and instead, soft tissue grafts such as Flex HD, Strattice, etc., are used as anchors. Tissue grafts are very strong, come in various thicknesses, and work very well, although they can be quite expensive. However, if the tissue graft offers a better success rate for symmastia repair, it is certainly worth the cost. Failure of a symmastia repair means more surgery and more expensive.
It is important to note that simply getting smaller breast implants does not cure symmastia. The pocket itself must be repaired, otherwise, no matter what size implants are put in, the symmastia will still be there.
If you consult with a surgeon that suggests using staples to literally staple (on the outside) of your cleavage area, find another surgeon. Symmastia must be repaired internally and cannot be repaired by using stables or suturing from the outside in.
Symmastia Repair Recovery
Once you have symmastia repair, you will likely be in a thong-style bra like the one pictured at the left. The purpose of this type of bra is to support the area in the cleavage, over top of the sternum. A thong-type bra puts pressure on this area, which aids in healing.
Most surgeons will recommend that you restrict your physical activity after symmastia repair, particularly when it is a symmastia repair on breast implants beneath the muscle. In the early part of recovery, it is important not to exert too much pressure on those muscles as you do not want to risk having them lift off the sternum again. Once that happens, there is no way to repair it other than going under the knife again.