What is Symmastia?
Symmastia is when breast implants are too close or touch each other in the center of the chest after a breast augmentation procedure. It is sometimes referred to as “UniBoob” or “Bread-loafing”. It can occur almost immediately after the initial procedure, or slowly develop over weeks, months, or even years later.
Causes of UniBoob
UniBoob or Symmastia is seen with implants placed above as well as below the muscle.
Releasing or cutting the pectoralis muscle
If the implants were placed below the muscle, it is caused by releasing or cutting the pectoralis muscle from the sternum (chest bone) in the center of the chest. The physician is usually trying to improve ‘cleavage’ for these patients.
Over-dissecting the implant pocket
If the implants were placed above the muscle, it can be caused by over-dissecting the implant pocket over the sternum, overly wide implants for a narrow chest, or the implants, with time, are pushed towards the center of the chest, causing the pockets to stretch and eventually the implants touch each other.
Patients at risk of developing symmastia
The typical patient who may develop symmastia is very thin and petite, with not a lot of tissue over the chest bone, and has a very large or wide implant in relation to their narrow chest.
Procedure for Symmastia Repair
The repair of symmastia can be very difficult depending on how thin the patient is, the extensiveness of the symmastia, the quality of the internal tissues, and the location of the implants above or below the muscle.
Treatment for implant above the muscle
The procedure is usually performed under general anesthesia and takes about 2 to 4 hours.
Removal of surrounding capsule
If the implants are above the muscle, usually they are removed with the surrounding capsule (capsulectomy) and replaced underneath the pectoralis muscle keeping it attached to the chest bone to limit movement of the implant to the center of the chest. The capsule is also opened on the side of the chest, to release pressure from the implant on the repair.
Treatment for implant below the muscle
If the implants are below the muscle, the repair is much more complicated.
Inframammary crease incision is used
Usually, an inframammary crease incision 2 – 3 inches in length is used. This gives the physician the best visualization to perform the repair.
Dissection of capsule from the top of the chest bone
The implant is then removed. The capsule is then opened from the top of the chest bone down to the bottom. The capsule is then gently dissected from the above breast tissue and the chest.
Reattachment of tissue
Next, the tissue under the skin (subcutaneous tissue) is reattached to the chest bone with interrupted absorbable sutures. The pectoralis muscle and fascia (the fascia holds the suture) is reattached to the chest bone with interrupted absorbable sutures also.
Use of sutures to reinforce the closing of the capsule
Next, the edges of the capsule are rolled up and sutured together to close the previously wide implant pocket and stop the implant from moving to the center of the chest. This is done with soft permanent interrupted sutures. Lastly, a running soft permanent suture is used to reinforce the closing of the capsule.
The opening capsule from the side of the chest
The capsule is then opened on the side of the chest to release pressure from the implant on the repair. If the implant was initially too wide for the chest, a smaller implant may be selected. Both saline and gel implants can be used. The implant is then replaced.
Closing the incisions
External pressure can be applied after the repair and before closing the incisions to assess the strength of the repair. The strength of the repair comes from putting the capsule back together with the soft permanent sutures. The incisions are then closed in layers. Drains are rarely needed. External sutures should not be used for this repair because of the poor success rate and the extensive scarring they cause.
Complications in the treatment
Closing all layers of tissue in thin patients
It should be noted, that patients who are very thin or have poor tissue quality might not be able to have all layers closed because the tissue is unavailable or tears from the sutures because of poor quality. But, all patients undergoing repair, should have some form of permanent suture closure of the capsule. This is the part of the repair that prevents the implant from moving back to the center of the chest.
Some surgeons may recommend using a synthetic graft, Alloderm – which is derived from porcine (pig) dermis, to give strength to the repair. If the symmastia occurs shortly after the original breast augmentation surgery, it is best to wait at least six months before undergoing a repair. This allows the capsule to form and thicken, so the repair can be performed.
Dressing after the surgery
The initial dressing varies from surgeon to surgeon. Some use gauze and tape, ace wrap, or a bra. Afterward, many physicians recommend wearing a thong bra or a specially designed garment that places pressure over the chest bone to help support the repair. This is usually worn for a minimum of six weeks after the surgery. Also, one should limit motions that contract the pectoralis muscle thus pulling on the repair, such as lifting or moving the arms above the head.
An alternate option for UniBoob Treatment
One last option for symmastia repair consists of initially removing the implants and capsules (capsulectomy), repairing the muscle if possible and closing the incisions. Drains are usually used. This allows the muscle to reattach to the chest bone. After about 4 to 6 months, the implants are replaced. This is usually reserved for patients with implants placed under the muscle, those who have failed a previous repair or have poor tissue quality making a strong repair difficult.