Synmastia/Symmastia

Your existing breasts should have a natural separation between them, which can be quite wide in some women or very narrow in others, but is rarely altogether absent. After your breast augmentation, this separation should still be roughly the same distance. In some cases, though, the implants become positioned incorrectly and touch in the middle, giving the appearance of one long breast.

There are several reasons synmastia can occur:

• Overdissection of the surgical pocket during your earlier breast enlargement procedure compromises the strength and integrity of the tissues that keep the implants apart. This can make the support tissues too weak to maintain proper implant placement, or the pocket may tear. This occurs most often in subglandular placement, and is typically the result of an overaggressive surgical technique or a technical problem during implant placement.
• Overdissection of the pectoral muscle insertion that runs along the sternum when implants are placed below the muscle, which leads to synmastia for the same reason as overdissection of the surgical pocket: the supportive tissues can no longer keep implants separate. Again, this is most commonly the result of surgical miscalculation.
• The use of breast implants that are too wide compared to the patient’s natural chest structure can cause synmastia, and women with existing chest deformities have a higher risk of synmastia due to anatomical reasons.
• Bigger implants, when properly positioned, aren’t more likely to end up moving toward the middle of your chest than small implants provided your soft tissues are adequate for the size of implant you are choosing. Since larger implants require larger surgical pockets, the combination of a significant increase in cup size plus or technical problems with the surgery could lead to synmastia.

Synmastia is usually diagnosed by your cosmetic surgeon, although there are a few telltale signs you may notice on your own that could indicate a problem; for example, if your breasts touch in the middle or if your skin looks “tented” between the breasts. You can test for synmastia by pressing your finger to your breastbone and noticing if your implants separate, then spring back toward the middle when you lift your finger again. When implants are properly positioned, they should be centered underneath your nipple, so nipples that seem to point outward or sit too far apart could also indicate the presence of synmastia.

The only treatment for improving the appearance of synmastia is surgery, although some women may wear a special separator bra under their clothing as a temporary solution. Revision surgery to correct synmastia is not as simple as downsizing to a smaller implant, because new surgical pockets have to be created or the existing pockets will require repair.