Though occurring far more commonly as a result of breast augmentation surgery, this condition can also manifest itself with breast reconstruction. It is not a rare problem but it can be quite challenging requiring very tedious and intricate techniques to correct. With the advent of AlloDerm®, Strattice® and other tissue matrix (dermal graft) options, the treatment can potentially be more predictable, desirable and permanent.

The following case of mine illustrates an example of a symmastia variant that was successfully treated with this approach. This is a 60 year old female who underwent an implant exchange a few years ago, replacing those which had been present from her breast augmentation performed 30 years. The symmastia occurred following this most recent procedure. She was very unhappy with the deformed appearance, contour irregularities, the substantial asymmetries, rippling of the skin which had developed and the limitations that she had in wearing many styles of clothes (photos A, C, and E). Notice the right breast with the implant extending well over to the left side and the associated irregular contour. The left implant is also significantly higher than the right.

A. Symmastia and deformities - before surgery

B. After surgery

C. Side view before surgery

D. After surgery

E. Before surgery - oblique view

F. After surgery - oblique view

Her breast revision and symmastia surgery consisted of exchanging her large broad implants for more projecting high profile implants that were smaller in volume and precisely placed. Contouring and repositioning of the tissues were performed and AlloDerm® tissue matrix graft was employed to meticulously secure and configure the breast implant placement.

The results shown just 7 weeks following the reconstructive surgery illustrate the substantial improvement in her breast positioning, contour and projection with resolution of the rippling that she was experiencing (photos B, D and F). Needless to say, she was quite satisfied with the outcome.

If you would like additional information on symmastia and its treatment, on breast augmentation, breast reconstruction or any other plastic surgery procedure or to schedule a consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

What are the causes and who is at a greater risk of developing this deformity? In general, women who are fairly thin and those who have a chest wall deformity known as pectus excavatum (where the sternum has a caved in appearance) are at a higher risk. This is risk is further amplified by a desire to have their breasts situated close together and by the selection of disproportionately large implants.

Symmastia is usually the result of overzealous dissection of the implant pocket medially (near the midline). In attempting to decrease the distance between the breasts so as to facilitate more cleavage, a surgeon may over-release tissue that is normally adherent to the underlying sternum. This allows the implants to migrate so far to the midline that they may actually touch. The skin then redrapes over the breast implants rather than discretely attaching to the sternum which results in the amorphous shaped uniboob versus two well defined breasts. Symmastia occurs both with breast implants that have been placed in submammary and submuscular pockets.

A few treatment options are available to correct this deformity including a relatively new approach using specially processed tissue (Alloderm® and Strattice®). Repair of symmastia can be very challenging and the results not always ideal. Selecting smaller and less wide implants will also assist in obtaining a more predictable and permanent correction.

If you would like additional information on symmastia, breast augmentation, breast implants, mastopexy or any other plastic surgery procedure or to schedule a consultation, you can call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona