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By Jerome Edelstein, MD

For the majority of women, there is a natural space between the right and left breast. This space creates a separation between the two breasts, so that they may both be defined as separate mounds. More importantly, it also defines the cleavage. Regardless of the size of your breast implants, it is important that this space remains for a more natural appearance.

However, if you notice that the space between your breasts has disappeared following your breast augmentation or the skin in the area is raised to a certain extent, then you have developed symmastia (a condition that can also exist congenitally). Informally referred to as “breadloafing”, symmastia is a very rare risk of breast augmentation that can occur due to improper implant placement probably caused by one or more of the following:

a failed attempt at enhancing cleavage

the cutting of tissues that let the implant drift out from its intended position, most often because the pocket is too large for the implant

excessively large implants, particularly in thin patients who have thin skin (as the skin can be pulled away from the chest bone)

the weakening and stretching of tissue that separates the breasts

Breast augmentation patients with chest wall abnormalities are also at a higher risk of developing symmastia.

Symmastia, aka Uni-Boob or Breadloafing: Breasts that appear as if joined together in the middle.Dr. Edelstein explains how to create great cleavage and avoid the Uni-Boob

The severity of symmastia varies, and it often causes the nipple/areola to appear off to the side of each breast. The condition can be safely corrected with surgery, but of course preventing it from occurring in the first place is always best.

Choosing an implant of the right size and shape for your body. The larger and wider the breast implant, the higher the risk of symmastia. While you can still get larger breast implants, it is important to understand that doing so can increase the risk. Having said this however, our Plastic Surgeons have performed breast augmentation on several patients who have chosen implants that are rather large for their body type, without any problems at all. This is because of their surgical skill and expertise.

Positioning the implants properly in the body using accurate surgical techniques and instruments. Blunt dissection and creating incisions in the body “blind” can increase the risk of symmastia, as they are not precise.

Creating a pocket for the implant that avoids an over-dissection of tissue in the cleavage area. The pocket should be “just right” – not too big and not too small. This involves an accurate surgical plan devised prior to performing surgery.

Placing implants under the chest muscle. The chest muscles insert into the chest bone on either side of the midline. When the implant is placed under the muscle, it is almost impossible to get symmastia.

Placing implants without trying to put them too close together, in a failed attempt to create cleavage.

Adapting surgical techniques for patients with chests that “cave in” (chest wall deformity).

Our Plastic Surgeons refine their surgical techniques to dramatically reduce the risks associated with breast augmentation, including symmastia.

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