What is Symmastia or “Uniboob”?

Symmastia is a condition where the two female breasts meet in the middle. Typically the female anatomy situates a flat area between the breasts above the midline sternal or chest bone. In rare cases seen in normal females, the breasts can meet in the midline but the skin is still attached to the underlying bone. When symmastia is created because of a breast augmentation, the breasts actually appear to meet in the middle and in many cases the skin over the sternal bone is actually lifted upwards so that the cleavage area is actually floating up off the chest bone. The appearance of this condition is often not so odd that it is obvious to the human eye, but when more carefully examined it is certainly not normal.
photos submitted by patient with symmastia - breasts that meet in the middle

What Causes Symmastia?

Symmastia is something that is seen too common after breast augmentation. The most likely cause is the use of breast implants that are too large for your chest dimensions (they simply don’t fit on your chest). In this case, the breast implants will expand over the midline of the chest and touch the other side. The cleavage area looks odd and is elevated off the sternal bone. If your surgeon over dissects the implant pocket in the midline this can certainly lead to symmastia as there is no normal anatomy to keep the implants separate. Women who have a concave shaped chest (funnel chest or sunken chest) are at higher risk for symmastia as the shape of the chest allows the breast implants to settle towards the midline of the chest. The typical female chest anatomy is sloped towards the sides (away from the sternal bone) so that breast implants are most likely to move to the side or down with time.

Symmastia Repair

The treatment of symmastia can be challenging. A “thong bra” is unlikely to separate the breasts once true symmastia is established. The tissue of the midline of the chest needs to be moved back down to the chest bone and secured with or without the help of acellular dermal matrix (a type of tissue used to build a new “internal bra” that keeps the breast implants separated from the midline). It is often advisable to select smaller breast implants if the primary cause of symmastia was the selection of overly large implants to begin with.

I have had much success in the treatment of symmastia with the use of innovative suture techniques internally and the use of higher profile breast implants that actually allow for larger breast implants if desired. It’s important for the patient to wear an appropriate bra after treatment to minimize the potential for recurrence of the symmastia. Patient satisfaction has been quite high with the creation of normal appearing breasts with beautiful, natural looking cleavage.

Most importantly, make sure that your surgeon is familiar with breast augmentation and that you choose an implant size and dimension that will fit your anatomy. If you are at higher risk of developing this condition because of your chest wall anatomy, make sure you wear an appropriate bra to keep your implants where they need to be. An ounce of prevention is worth a pound of cure!