Symmastia Surgery

Symmastia is a rare congenital anomaly in which soft tissue connects, or webs, both breasts across the midline anterior to the sternum. It can be surgically corrected by a plastic surgeon.
The term is also very commonly used in plastic surgery to describe a similar appearance that occurs undesirably following breast augmentation.
Definition:
Symmastia is a cosmetically undesirable circumstance in patients with breast implants which occurs when implants come too close to the midline of the chest. This results in a lifting of the skin from the chest wall and creates the dreaded “unaboob” appearance; This usually happens as a result of the overly-aggressive release of the chest muscle during implant surgery, extending the release to the mid-chest.Correction of this condition via breast revision surgery usually involves removing the implants and closing the space in the middle of the chest with internal sutures. This approach works best when implants remain out of the body for a period of time after surgery and are then reinserted after approximately 12 weeks (or more), allowing the body time to heal. If the implants are replaced too soon following the corrective procedure, the effects of gravity and pressure of daily activities may cause the problem to recur.
 About Symmastia
Symmastia, or webbed breasts, is a rare congenital breast deformity which results to the webbing of the two breasts right in the middle of the chest, connected via a soft, web-like tissue. This would look like there is only one breast, instead of two.
The same effect can also occur if an over-dissection were to happen during breast augmentation surgery. Although the original intention of the operation is to  increase cleavage depth, the implants can end up touching each other in the middle of the chest, crossing over the sternum, resulting in another form of botched breast implants.
Other terms coined for symmastia are “bread loafing“, “kissing implants“, and “uni-boob“.
Here is how symmastia occurs after an operation. To get the implants closer together to form a cleavage, the surgeon has to release soft tissues that cover the sternum, or the breastbone. The normal anatomical attachments of skin and muscle at the medial parts of the breasts where the cleavage normally rests are surgically disrupted, and the skin between the breasts is lifted. This increases the probability of the implants meeting at the middle, and the resulting defect is the webbed breast appearance.
The condition of symmastia does not usually appear right after the surgery. It would take months for this condition to develop and become noticeable. This also seems to affect thin women more than larger women, especially if implants that are too large are used on them because they have less tissue and fat covering the breastbone.

Breast Revision

Breast revision is a surgical procedure to correct the occurrence of webbed breasts. In this procedure, the fat and tissues in between the breasts needs to be reattached to the breastbone. It involves the removal of the implants, and closing the space in the middle of the chest with the use of internal sutures. It starts with cutting the tissue that encloses the implant, after which tissue will then be sutured to keep the implant intact in place. The muscle is then seamed inside, connected to the sternum. Finally, the incision will be closed with another set of sutures.
The option of removing the implants is also made possible during this operation. This method can work best if the body is allowed to heal after a specific period of time. This can be achieved by waiting for around twelve weeks or more before putting back the implants. Putting them back in too soon after the procedure may just cause symmastia to recur via the effects of gravity and the strain of day-to-day activities.
After surgery, the patient is recommended to take plenty of bed rest, and increased fluid intake. Several medications and follow-up check ups will have to be scheduled, and the breasts are expected to feel sore during the recovery period.
To support and maintain the separation of the breasts, a certain form of brassiere and a bandeau called the “thong bra” needs to be worn. The thong bra is worn underneath the main brassiere, and its middle part lies between the busts to separate both breasts. This is intended to allow the area sutured to heal properly without straining it, and to induce the attachment of tissues and fats to the sternum.
procedure
Medial confluence of the breasts, known as symmastia, occurs when two breast implants touch or are very close to one another in the center of the chest just above the sternum in the cleavage area. This occurrence, which can produce a web across the midline, is commonly referred to as bread loafing or uniboob, giving the appearance of tow breasts connected underneath the skin as the skin and tissue is pushed up. A possible consequence of unopposed muscle action with overzealous medial release causing aesthetic disfigurement and additional issues with discomfort and apparel problems, symmastia is a difficult surgical complication to address.

Patients with multiple breast operations, excessively large implants or overaggressive medial dissection are susceptible to developing symmastia. Symmastia seems to be more prevalent among thin women mainly due to the fact that thin women usually have less tissue or fat covering the sternum. Also, patients with pectus excavatum, a depressed breastbone, are more prone to symmastia. Pectus excavatum may cause the implants to slope inward, toward the cleavage area, creating more pressure on the tissues in that area, resulting in symmastia. Attempts to increase cleavage by releasing the soft tissues or inner origins of the pectoralis muscles lead to symmastia by surgically interrupting the natural barriers of tissue and muscle at the medial location of the breasts where the cleavage is normally defined. For instance, if the horizontal muscle, which lies on top of the sternum dividing the implants, is cut, then the possibility of the implants settling towards the middle of the chest is increased. This complication may occur when implants are placed either underneath or above the pectoral muscle.

Symmastia is difficult to treat and recurrence is common. Correction requires combined restoration of the initial presternal subcutaneous integrity and medial closure of the pocket. In order to repair symmastia, the space between the 2 implants must be securely closed off. The combination of medial closure of the breast implant pockets and suturing of the preseternal soft tissue to the sternum periosteum provides one satisfactory option to the surgical reconstruction of symmastia. Often, it is necessary to open the breast implant pocket laterally (to the sides) to decrease pressure along the cleavage area. There are several methods used to correct the deformity, such as allogenic dermal grafting, fibrin-based tissue glue, and delayed filling of an adjustable implant.

Before the surgical procedure, careful markings are done with the patient in the upright and laying position. Often, symmastia co-exists with other breast implant malposition problems and breast asymmetry. These issues should be addressed as well.

Symmastia Facts

The condition can affect women immediately after augmentation surgery or at any time in the future. Most cases present themselves within 4 months after breast enlargement surgery. The condition can occur in submuscular, subglandular, subfascial or subpectoral placements. There are varying degrees of symmastia, ranging from overly enhanced and pushed together cleavage to the complete joining of the breasts into one solid structure.

Causes of Synmastia

Breast implant migration can be caused by any number of factors working as a sole causation, or in combination with each other. These causative criteria include:* Over dissection of the implant pocket close to the center line of the chest. This is an iatrogenic surgical error and is the sign of a poor or inexperienced plastic surgeon.

* Implant size or width is too large for the patient’s anatomy.
* Implant migration is more common in women who have undergone more than one augmentation procedure.
* Anatomical tissue structure and musculature can play a role in encouraging implant migration.
Generally, implant migration is due to direct surgical error or poor planning on the part of the operating cosmetic surgeon.

Treatment for Synmastia

Breast implant migration is a difficult condition to repair. There are a variety of treatments which are used to reverse the chest deformity. External suturing through the skin is a poorly designed treatment which often leaves considerable visible scarring and rarely corrects the condition permanently. A far better choice is implant revision surgery in which the pockets will be reinforced from the inside. Scar tissue will be rolled into the inner aspect of each implant pocket, strengthening it and allowing the placement of permanent internal sutures to hold the skin and tissue to the breast bone. Once the pockets are fixed, the implants can be reinserted without recurrence. Additionally, a T-front or “thong” bra is often prescribed to help maintain the space between breasts during the healing process.

 

Recommendation on Synmastia

This is a very disturbing condition for any affected patient. Severe cases really distort the body and create a visually frightening appearance. Add to this fact the difficulty of correction and you have a real problem on your hands. Learning which procedures work well for implant migration correction is half the battle. Avoiding poorly planned or ineffective treatment strategies will save you considerable time, suffering and money, as you look for a permanent cure for your symmastia problem. Make sure to hire a knowledgeable and experienced corrective surgeon who can ensure good results from any reparative procedure. If you have patience and follow an indicated surgical correction regimen, you will finally achieve the beautiful breasts you desired from the beginning of your augmentation experience.