One of the complications (although rare) related to breast augmentation with implant placement is post-surgical symmastia, also known as the "uniboob effect" or loss of the intermammary groove. Often, this issue not only causes discomfort but also associated discomfort such as pain and a sense of tension between the two breasts.
Why is the procedure performed?
Symmastia can be either a surgical or congenital complication. In the first case, it can arise either due to improper placement of breast implants with the creation of surgical pockets so close to the midline of the chest that the integrity of the connective tissue above the sternum is compromised, or due to the insertion of breast implants that are too large so that the space between the breasts is reduced. In the case that it is congenital, symmastia is present from birth and is common in women who have particularly large and developed breasts, with the medial part of the breast very closely joined and attached.
What needs to be done before surgery?
It is necessary to undergo a consultation with the plastic surgeon who will assess whether you have this complication and its degree of severity: symmastia can be mild or severe. A severe case often involves a complete union of the two breasts and a complete detachment of the skin from the sternum leading to both functional and aesthetic problems of the breasts. It is also necessary that at least 6 months have passed since a previous surgery.
How is the surgery performed?
Symmastia correction surgery is a very complex procedure because a true reconstruction of the line on the sternal plane between the two breasts is performed. During the surgery, the old implants are removed and the space between the two breasts is recreated by internal reconstruction along the medial part of those tissues that have lost their adherence to the sternal plane. In more severe cases, it is necessary to use a biological scaffold or GalaFlex, a biopolymer mesh, which is useful in making the reconstruction more stable and decreasing the risk of recurrence since it better distributes the load of the implants over the reconstructed area. When choosing new implants, it should be advised not to use ones that are larger than those that were removed in order to correct the symmastia. Whenever possible, always try to maintain the same access as in the previous surgery. The duration of surgery is variable depending on the patient's baseline condition and the complexity of the symmastia. The surgery is performed under general anesthesia with a one-night stay in the clinic. Most of the time, drains are required.
What happens after the operation?
Recovery time from symmastia correction surgery ranges from 1 to 2 weeks, and work activities can be resumed after 7 to 10 days. However, heavy lifting or strenuous physical activity should be avoided for 4-6 weeks. Swelling and increased sensitivity are common discomforts. The use of a surgical bra helps promote rapid healing.
In order to reduce postoperative pain, anti-inflammatory and pain medications will be prescribed. In order to reduce the risk of infection, the patient will be given antibiotic therapy.
Usually, in the correction of symmastia, the scar from the previous breast augmentation surgery is used. However, the scar will be slightly larger.
The result of the surgery depends on several factors: the patient's initial clinical condition, the patient's ability to heal, and adherence to the postoperative instructions given by the surgeon: avoid inappropriate movements, refrain from sun exposure until the scars are completely stabilized. The final profile will be visible after about a year, but the results and benefits will be appreciable right away.
What are the possible risks?
Symmastia can run the risk of recurrence, especially if it is very severe. The possibility of this occurring is quite rare, but can still happen precisely because of complete detachment from the sternal plane. In some cases, it is very difficult to correct and especially in patients who want particularly large breasts.