South Florida Plastic Surgery Associates - Don R. Revis, MD











Symmastia / Synmastia

Identifying and Correcting Synmastia or Symmastia in Breast Implants

Synmastia (also called uniboob or breadloafing; often misspelled as symmastia) is a specific example of a post-operative problem requiring a thorough, systematic approach and innovative surgical techniques. This is one of the most dreaded complications following breast augmentation, and the permanent correction of synmastia is one of the most difficult problems facing a plastic surgeon. This is why it is critical that you find a plastic surgeon with extensive experience in the correction of synmastia and one who is confident in his or her own technique.

Synmastia Correction: Before and After Photos Synmastia Correction: Before and After Photos
Before After
Photos show a 27 year old patient with synmastia, at pre-op and six months post-op. Synmastia repair with bilateral Internal Bra procedure was perfomed; implant exchange from moderate profile saline filled to 370cc to moderate profile saline filled to 425cc.

What is synmastia (symmastia)?

Synmastia (shown below) is present when one or both implants are positioned too close to the midline over the breastbone (sternum). This means that the pockets, or capsules, surrounding the implants are too medially placed.

Example of Symnastia (also known as Breadloafing or Uniboob)

This most often represents overdissection of the pocket in the region of the cleavage during surgery. The worst case Dr. Revis has seen is one in which the breasts had one capsule that was continuous from one breast to the other. In other words, the implants could both be squeezed into the right breast side of the pocket or they could both be squeezed into the left breast side of the pocket. The opening in the middle between the two pockets was approximately three inches in diameter.

What are the symptoms of synmastia (symmastia)?

Many patients report that their synmastia is accompanied by mild discomfort in the midline with or without rippling.

How is synmastia (symmastia) diagnosed?

Symnastia is usually diagnosed by the patient or by a plastic surgeon. An experienced plastic surgeon should be able to diagnose most cases of synmastia from photos alone.

When diagnosing yourself, you may find that your breasts touch in the middle, that the skin has lifted off of the breastbone (sternum), or that there really is no separation between the breasts because the skin tents from one breast to the other.

When you push your finger down onto the breastbone in the middle of your chest, your implants may separate but then spring back towards one another when you remove your finger. You may also notice that when you bend forwards and look between your breasts there really is no indentation in the midline between the breasts.

Proper implant position means that the nipple is centered on the center of the breast implant. If more of the implant rests medial to the nipple than lateral to the nipple, then you may have synmastia. When this nipple-implant malposition occurs, it may make the nipples appear to point outwards (called walleyed) or may make the nipples appear to be too far apart. This appearance results from the fact that as the implants migrate medially the nipples rotate outwards, giving the walleyed appearance.

Can synmastia (symmastia) be corrected non-surgically?

Unfortunately, in Dr. Revisí experience he has found that the internal bra procedure is required to correct synmastia. Synmastia may be temporarily camouflaged in clothing using a separator bra, but this does not create any permanent solution to the problem.

Separator Bra for Synmastia

Will switching to smaller implants correct synmastia (symmastia)?

Switching to smaller implants alone will not correct synmastia. Synmastia is a pocket problem, not an implant problem. In my experience the only true, long term correction for synmastia is an Internal Bra procedure.

Synmastia Correction: Before and After Photos Synmastia Correction: Before and After Photos
Before After
Photos show a 25 year old patient with synmastia, at pre-op and 4 months post-op. Synmastia repair with bilateral Internal Bra procedure was perfomed; implant exchange from high profile saline filled to 320cc to high profile silicone 450cc.

How can synmastia (symmastia) be corrected?

To correct synmastia, Dr. Revis uses the Internal Bra technique. Using special lighted retractors, Dr. Revis expands the implant pockets (capsulotomy) superiorly and laterally, creating room for the implants to be repositioned further apart in the midline, creating better separation and a more pleasing appearance.

Dr. Revis then closes the part of the pockets that rests too medially over the sternum using the Internal Bra technique. This repairs the connection of the overlying skin and muscle to the underlying breastbone or sternum thus preventing the implants from resting too close to one another in the middle of the chest. Dr. Revis uses permanent sutures for a long-lasting result. These sutures are carefully placed so that the suture material is never in direct contact with the implants inside the body.

Synmastia Correction: Before and After Photos Synmastia Correction: Before and After Photos
Before After
Photos show a 26 year old patient with synmastia, at pre-op and 12 months post-op. Synmastia repair with bilateral Internal Bra procedure was perfomed; implant is moderate profile saline filled to 525cc.

May I switch to larger implants when I have my synmastia (symmastia) corrected?

Absolutely. Approximately 40% of patients who undergo the Internal Bra procedure keep the same size implants, 40% increase the size of their implants, and the remaining 20% reduce the size of their implants. The size/weight of the implants has no relationship to the success or the long-lasting nature of the synmastia repair with the Internal Bra technique when it is performed correctly with permanent sutures.

May I see examples of the Internal Bra procedure for the correction of synmastia (symmastia)?

Please click the links below to review pre- and post-operative photos of the Internal Bra procedure for synmastia, as well as numerous examples of other breast implant problems.

Synmastia Repair Before & After Photos
Breast Augmentation Revision Before & After Photos

Please call (954) 630-2009 for further information or to schedule your complimentary consultation.

Email: DrDonRevis@hotmail.com

 

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