What is symmastia?
Symmastia is usually a result of over-dissection of the tissues in the cleavage area. This over-dissection is sometimes done intentionally in hopes of creating or increasing cleavage - other times, its unintentional. Symmastia is commonly referred to as "breadloafing", or "kissing implants", or "uniboob". With this condition, the implants actually meet in the middle of the chest, giving the appearance of one breast, instead of two. Symmastia seems to be more prevalent among thin women, mainly due to the fact that thin women usually have less tissue and/or fat covering the sternum. Sometimes, the surgeon will attempt to release some of these tissues, in order to get the implants closer together. If you have a qualified, and experienced plastic surgeon, this is a complication you shouldn't have to worry about. It is the least common of all cosmetic breast augmentation complications.
Women with pectus excavatum are more prone to symmastia, especially if they do not find a surgeon who is skilled at placing implants in women with chestwall deformities. Pectus excavatum (a depressed breastbone) will cause the implants to slope inward, toward the cleavage area. This creates more pressure on the tissues in that area, and may result in symmastia. Some doctors recommend placing smaller implants in women with PE, since this will reduce the amount of pressure that is placed on the cleavage area. To learn more about this, and to view photos, please visit Dr. DeWire's page on cleavage determanints.
How is symmsatia repaired?
Symmastia may or may not be noticeable right after surgery. It can appear at anytime after surgery from a few days to several months later.
In order to repair symmastia, the fat and underlying skin tissues will have to be reattached to the breastbone. Often times, with submuscular implants, the scar tissue is removed from the pocket, then rolled up. This gives the sutures something to adhere to, or "hold on" to. Permanent sutures are used to hold the sternal skin down. The remainder of the pocket has to be sutured as well, usually with permanent sutures, thus providing barriers, which will keep the implants from migrating across the breastbone again. In order to remove all pressure/tension from the middle of the chest (sternum or breastbone), the pocket usually has to be made larger, or, the implants will have to be exchanged for smaller ones. Once the surgery is complete, a thong-bra is usually required, along with something like a rolled up ace bandage, which is used in between the breasts to put pressure on the sternum.
It's very important to know that all of the sutures that are used should be INTERNAL sutures. External sutures will only add to the scarring, and is not recommended, since this repair must be done internally.
Symmastia Repair / Rhinoplasty Video
Video courtesy of Dr. David Kim of Beverly Hills, CA.