Article
Symmastia
Symmastia ("uniboob") is a condition where the natural cleavage space (intermammary sulcus) is lost and breast tissue or implants connect across the sternum, creating a continuous mound. It may be congenital (rare) or iatrogenic (caused by surgery—most commonly overly aggressive medial pocket dissection in augmentation or reconstruction).
Causes (Iatrogenic)
- Over-dissection of the medial pocket compromising the sternal soft tissue attachments
- Oversized implant relative to thoracic width
- Use of high-profile implants squeezed medially for exaggerated cleavage
- Capsular contracture with medial displacement (less common)
Clinical Features
- Flattened or elevated skin bridge over sternum
- Loss of normal vertical cleavage line
- Implants appear too close or touching
- Possible discomfort or dissatisfaction with unnatural look
Correction
- Pocket revision: medial capsulorrhaphy (suturing capsule to re-create medial boundary)
- Size adjustment: downsizing or changing profile
- Use of acellular dermal matrix (ADM) / mesh to reinforce repaired medial zone (reconstruction contexts)
- Delayed approach in presence of active infection or severe contracture
Writing Tips
- Describe the visual continuity: "a seamless swell across her chest".
- Emotional nuance: tension between dramatic cleavage and awareness of surgical overreach.