9 November 2021
One of the complications that most frightens patients planning to undergo breast augmentation surgery is symmastia, also known as the "uniboob effect" or loss of the intermammary groove.
Although it occurs in very rare cases, it is one of the complications related to breast augmentation with implant placement.
First of all, it should be clarified that symmastia can be congenital, i.e., present at birth, and is common in women who have particularly large and developed breasts with the medial part of the breasts very closely joined and attached. This type of symmastia is the most complicated to correct precisely because it is an anatomical component of the patient's body.
Symmastia, unfortunately, can also be a surgical complication.
This complication sometimes arises because of the willingness of perhaps less experienced physicians to accommodate the demands of patients who often think that the most beautiful breasts are those with an extremely small gap between them. The surgeon then goes on to force a more pronounced detachment of the medial part, resulting in a complication.
In other cases, the cause of simmastia is 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.
Furthermore, symmastia can be mild or severe, and severe symmastia often results in a complete union of the two breasts and a complete detachment of the skin from the sternal side leading to functional problems of the breasts as well as cosmetic ones.
Symmastia correction surgery is not an easy surgery to perform. In fact, it can be very complex because a true reconstruction of what is the line on the sternal plane between the two breasts must be performed.
In more severe cases, in addition to the normal and simple sutures, it is necessary to use a mesh such as GalaFlex (made of P4HB and known as poly-4-hydroxybutyrate) or biological scaffolds, which allow the natural shape of the breast to be recreated and then go on to correct the symmastia.
It should be mentioned that simmastia, especially if it is very severe, can face the risk of recurrence. The possibility is quite rare, but it can still happen precisely because complete detachment of the sternal plane in some cases is very difficult to correct, especially in patients who want particularly large breasts.
One of the questions I am asked most frequently by patients who want to correct symmastia is whether they can put in larger implants.
Paradoxically, even if the patient's desire is to increase breast volume and put in larger implants, increasing the traction on that sternal plane that is now effectively detached makes the resolution of the symmastia even more difficult.
In fact, the stitches and/or mesh that are placed to correct this complication would be subjected to even greater traction with larger implants increasing the risk of subsequent recurrence.
In extremely large and voluminous breasts, in order to correct the symmastia, midline reconstruction of the sternal plane often needs to be reduced and combined with a mastopexy.
Usually, in the correction of symmastia, the scar from the previous breast augmentation surgery is used.
Clearly, in the case of volume reduction of particularly large breasts, the scar will be different because the correction will be combined with a mastopexy.
The duration of the surgery is variable depending on the patient's starting condition and the complexity of the symmastia.
In cases where mesh insertion is needed, it can last more than two hours.
The surgery is performed under general anesthesia with a one-night stay in the clinic.
Before undergoing breast augmentation, it is essential to rely on a competent and trained plastic, reconstructive, and aesthetic surgeon who can assess the feasibility of the procedure in light of the patient's requirements.
The risk of symmastia is reduced when the patient together with the surgeon choose a breast size and spacing between the breasts that are appropriate for the woman's anatomical features.
To receive more information about symmastia correction surgery and its cost, contact me for a consultation at one of my offices in Rome, Milan, Caserta or Den Haag (NL).