The term “uniboob” is an informal description for a cosmetic complication following breast augmentation surgery, medically known as symmastia. Symmastia is a recognized, though relatively uncommon, issue in plastic surgery where the implants migrate toward the center of the chest. Understanding the physical characteristics, underlying causes, and specialized surgical techniques required for correction is important for anyone considering or recovering from implant-based breast surgery.
Symmastia: Definition and Visual Characteristics
Symmastia is medically defined as the confluence of the breast pockets across the midline of the chest, resulting in the elimination of the natural cleavage line. The physical manifestation is a lack of separation, causing the two breasts to appear merged into a single, continuous mound. This condition occurs when the skin and underlying soft tissues that normally anchor to the sternum, or breastbone, become detached or stretched. This detachment allows the breast implants to shift medially, creating a tented appearance of skin over the central chest. In more pronounced cases, the implant mobility is noticeable, with the implants easily pushed together or moving towards the center when lying down.
Primary Causes and Contributing Risk Factors
The development of symmastia primarily results from the surgical creation of an implant pocket that extends too far toward the body’s midline. During augmentation, the surgeon must carefully dissect tissue while preserving the sternal fascia and pectoralis muscle attachments. When this dissection is performed too aggressively, it compromises the tissue integrity between the breasts, allowing the two separate implant pockets to communicate and merge into a single space. This over-dissection weakens the connective tissue that secures the skin and muscle to the sternum, permitting the implants to migrate inward.
Implant Size and Placement
A specific risk factor is selecting implants that are too wide for the patient’s natural chest anatomy. Implants exceeding the available space place excessive tension on the medial tissue, which can lead to tissue breakdown and shifting. The plane of implant placement is also a factor. Subglandular placement (over the pectoral muscle) is associated with a higher risk compared to submuscular placement (beneath the muscle). The muscle offers an additional layer of support that helps stabilize the implant pocket and prevent medial migration. Patients with a naturally narrow sternal space or chest wall deformities, such as pectus excavatum, are also more susceptible to this complication.
Surgical Methods for Correction
Correcting symmastia requires revision surgery to restore the integrity of the midline separation. The goal of this procedure is to recreate a stable, separate pocket for each implant and re-anchor the soft tissue to the breastbone. One primary technique is capsulorrhaphy, which involves surgically tightening the inner portion of the implant capsule and suturing it back to the chest wall.
Internal Reconstruction
Specialized internal sutures are frequently employed to reconstruct the medial boundaries of the implant pocket, a technique often referred to as an “internal bra.” This internal support system uses strong stitches to secure the tissue. Surgeons may also use reinforcing materials, such as synthetic mesh or acellular dermal matrix (ADM), to add strength to the repair, especially if the patient’s native tissue is thin. In many cases, the existing implants are replaced with new ones that are smaller or narrower to ensure they fit the reconstructed pocket without placing undue tension. Following the revision, patients wear a specialized external compression bra or strap. This device applies continuous pressure to the center of the chest, promoting scar tissue adhesion and stabilizing the cleavage line during the initial healing period.