Symmastia Repair

What is symmastia? Symmastia is the abnormal positioning of the breasts or the breast implants such that the two breasts are touching in the midline or that one breast is significantly closer to the midline than the other. In some cases, the implants can actually be felt to be crossing the sternum, or the midline, and even connecting to the other side.

It is ultimately almost always caused by surgery that created too big a space for the implant and in particular too big a space towards the middle of the chest.

Most of the time, this is associated with implants that have been put under the muscle, but in some cases, it can even occur with implants put on top of the muscle.

It used to be thought that the best and only way to correct this would be to take the implants out and to leave things to heal for several months and then to come back and put new implants in a new space that was dissected or created more or less from scratch.

Several years ago, I actually wrote the first article on how to correct this and coined the term “capsulorrhaphy.” This essentially meant using sutures to close off the space that was too close to the middle and to do it on both sides and then to replace the implants simultaneously.

This was the first relatively early and in retrospect crude way of fixing the problem, which worked but which was very difficult to do surgically and was not popular. If the implants were subglandular, they could be switched to subpectoral and that would help with the problem. But since the problem is usually with subpectoral implants, that was rarely the right solution.

Recently myself and a few other thoughtful surgeons designed a newer operation to solve the problem, which is both easier and more reliable. This operation is called the neosubpectoral pocket, or the neo pocket, or the neopectoral pocket.

Essentially, what this operation allowed us to do was to recreate a new space at the same time as we closed off the old space, but in this case, we closed off the old space entirely rather than just partly with a capsulorrhaphy.

This operation has subsequently caught on pretty widely around the world and is considered a major breakthrough in how to solve not just symmastia but lots of other implant malposition problems and even in some cases the problem of capsular contracture.

Even more recently, we became aware of the option of buttressing or reinforcing these repairs using in most cases something called acellular dermal matrix material, or ADM. Essentially, what ADM does is allows us do the repair using the neosubpectoral pocket and then to reinforce or protect the repair with the ADM, much like flashing protects a skylight from leaking.

In most cases, we use this tissue-based patch, or ADM, but more recently, surgeons have been substituting tissue-based patches with synthetic patches such as Galatea or even Vicryl mesh.

In addition to doing a surgical repair, which can almost always be done in one sitting rather than having to remove implants and wait for a period of time, we now also recommend picking an implant that more likely will better fit or fill the space, which often means a narrower implant than what was originally used. In some cases but not all cases, part of the problem is not just that the space was overdissected or overcreated, but also that the implants were probably too wide initially to fit the woman’s anatomy or chest size.

Although the development or the recognition of symmastia is a disappointing experience for a woman with breast implants, the good news is now that can be reliably corrected, particularly by surgeons who are well-experienced with the techniques as described above for its solution.

I encourage you to seek out surgeons such as myself, who I am confident have the expertise to solve this problem.