Symmastia: When the natural separation between the breasts is lost
Symmastia refers to the loss of the natural separation between the breasts and is a rare, serious complication following breast augmentation.
An aesthetically pleasing cleavage with a natural-looking separation between the breasts is a goal for many patients undergoing breast augmentation. In rare cases, however, a serious complication can arise in which this very separation is lost: the Symmastia. The result is sometimes colloquially referred to as a „uniboob“ or „monoboob“.
This glossary entry explains in detail what symmastia is, how it develops and why correcting it is one of the most challenging procedures in revision breast surgery.
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Important note
This article is for information purposes only and is not a substitute for a medical diagnosis or advice. If you are unsure, or if you require a personalised treatment plan, it is essential that you consult a qualified specialist.
What is symmastia?
Symmastia is a rare complication that occurs almost exclusively following breast augmentation with implants and is usually caused by the operation itself (iatrogenic). It refers to a condition in which the boundary between the two implant pockets is eliminated in the centre, above the breastbone (sternum).
This causes the natural separation between the breasts to be lost, and the implants meet in the middle, resulting in an unnatural, bridge-like appearance of the cleavage.
The causes: What leads to symmastia?
The development of symmastia is a direct anatomical problem. The breastbone (sternum) forms the stable midline of the chest. The overlying muscle and connective tissue is normally firmly fused to the bone and acts as a natural, robust barrier separating the two breasts. Symmastia occurs when this central tissue barrier loses its integrity.
The main causes are:
- Implants that are too large: Implants whose width exceeds that of the patient’s chest may exert increased pressure on the tissue barrier between the breasts and weaken it over time.
- Incorrect surgical technique: Preparing the implant pockets too aggressively inwards, to the extent that the muscle and fascial attachments to the sternum are detached, destroys the natural septum.
- Anatomical predisposition: In very rare cases, a congenital weakness of the connective tissue in the centre of the breast may also contribute to its development.
The correction: A complex revision procedure
Correcting symmastia is a complex procedure and requires the highest level of surgical expertise. Simply „stitching it back together“ is not enough. The procedure usually involves several steps:
- Removal of the implants: In many cases, the existing implants are removed first, particularly where there is severe symmastia or the implants have shifted.
- Reconstruction of the centre line: This is the crucial step. The surgeon must reattach the inner edges of the implant pockets to the sternum using strong, often multi-layered sutures. Sometimes this suture is reinforced using special suture material or even by incorporating the patient’s own tissue or artificial matrices (meshes).
- Capsule removal or reduction: The implant capsule can be removed, reduced or modified in the midline region to stabilise the new septum.
- Choosing new implants: In most cases, smaller and narrower implants must be used during correction to reduce the pressure on the reconstructed midline.
Prevention: The crucial role of choosing the right dentist and implant
The best treatment for symmastia is to prevent it from occurring in the first place. Prevention lies largely, though not exclusively, in the hands of the surgeon; the patient’s individual anatomical characteristics also play a role.
- Information: Realistic expectations and clear advice are essential.
- Choice of implant: Implants must fit the individual’s anatomy precisely.
- Surgical technique: Working carefully and gently helps to prevent complications.
Risks and safeguards for audit procedures
Correcting symmastia is a complex and costly revision procedure. As it is usually regarded as a complication of cosmetic surgery, statutory health insurance schemes do not generally cover the costs. This underlines the enormous importance of a Consequential Costs Insurance, the before once the original procedure has been completed. It is specifically designed to cover the financial costs of medically necessary treatment following complications.
Frequently Asked Questions (FAQ) about symmastia
From a medical point of view, it is not usually harmful to general health. However, it causes considerable aesthetic and psychological distress for those affected and requires complex corrective surgery.
No. As this is a structural, anatomical problem (a tear in a layer of tissue), symmastia can never resolve itself.
It may be visible immediately after the operation if the tissue plane was compromised during the procedure. However, it can also develop gradually over months or years if the pressure from implants that are too large slowly stretches the tissue.
As symmastia is a recognised complication but one that is not usually covered by health insurance, patients must, in most cases, bear the costs of the corrective procedure themselves – unless there is demonstrable medical negligence or a medically necessary secondary complication arises. Insurance covering follow-on costs can provide patients with sensible financial protection in the event of complications such as symmastia.