FAQs: Symmastia of Breast Implants After Breast Augmentation

Symmastia ("breadloaf") of Breast Implants

What is Symmastia?

Sometimes referred to as breadloafing due to its appearance, this condition is caused when breast implants move to the center of the chest and look as if there is one implant across the chest.

This condition can occur in women who undergo submuscular breast augmentation when the muscle that is attached to the sternum and goes horizontally across the implants has been cut by the surgeon. It can also occur when an implant is used that is too large or because of a tissue failure in the patient.
When this occurs, everything can appear fine immediately after surgery. Within a few days, however, the pressure of post-operative swelling forces the implant to move and since the muscle that would hold the implant or implants away from the cleavage area has been cut, the implants move toward the center. As a result of the pressure the tissue can lift from the sternum and allow the implants to move into the center, causing the appearance of one large implant across the chest (hence the term “breadloafing”).

Repair of Symmastia with Breast Implants

To repair symmastia, the implants will be removed, typically through a crease incision and corrective work needs to be done and it should be done on the inside. If your doctor recommends external sutures (see photos), please consult a second plastic surgeon. External sutures, which involve sutures from the outside and down into the sternum, will cause additional and significant scarring in the cleavage area and the chances of the external repair being successful are minimal.

The correct repair of symmastia is an internal repair. The surgeon will cut scar tissue out of the cleavage area and roll it back into the pocket. These "rolls" will give the surgeon something to put permanent sutures into and the thickness of the rolls will give strength.

The surgeon will reattach the muscle with a row of permanent sutures. Then, the surgeon will put a row of permanent sutures in the cleavage area running down the side of each breast, curving at the bottom to make it look as natural as possible. Then, the surgeon will put a row of dissolvable sutures on each side of the cleavage. This will help to hold the cleavage down until the raw surfaces have time to heal together. This can cause the skin to pucker, but when the stitches dissolve, the skin smoothes back out. Then the implants are placed back in and the bottom of the breast is resutured.

Photo courtesy of Dr. Tom DeWire, Richmond, VA Plastic Surgeon.

Click here for more pictures of symmastia.