When breast implants migrate medially past the sternum, the pockets merge and the natural separation between the breasts is destroyed — a condition known as symmastia, or colloquially, "uniboob." Correcting it requires surgically rebuilding the medial pocket boundary anchored to the sternum. This is one of the most technically demanding procedures in breast revision surgery. Dr. Tachmes has treated complex symmastia cases including those after multiple failed revision attempts.
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Symmastia is a deformity in which the breast implants migrate too far medially — toward the center of the chest — causing the skin over the sternum to lift away from the chest wall and the implant pockets to communicate or merge across the midline.
In natural anatomy, the skin over the sternum is firmly attached to the underlying bone by soft tissue bands. When implants are placed too medially, or when the medial pocket boundary breaks down over time, these attachments release. The result is a loss of the natural separation between the breasts and an unnatural appearance where the chest looks like a single continuous mound.
Symmastia can range from mild (skin tenting over the sternum, slight loss of cleavage definition) to severe (complete merging of both implant pockets with dramatic soft tissue distortion across the sternum).
It is notoriously difficult to correct because the sternum has limited soft tissue for suture anchoring, and the forces that caused the original deformity continue to act on any repair. Recurrence rates after correction are significant, which is why technique and patient selection matter enormously.
• Skin over the sternum "tents" upward and away from the chest wall
• You can feel implant material extending across the midline when pressing inward
• Natural cleavage separation has decreased or disappeared
• Both breasts appear connected as a single unit from above
• A visible "window" between the skin and sternum when viewed from the side
• Implants feel as though they are under the skin of the sternum rather than the breast
Some patients attempt to restore medial separation using tape or specialized bras. These provide temporary visual improvement at best and can worsen the underlying tissue damage by placing continuous pressure on the already compromised sternal skin. They do not address the structural problem.
Surgical correction is the only lasting solution.
Over-dissection during augmentation: The most common cause. If the surgeon creates the pocket too close to the midline, the implant sits against the sternum and gradually erodes the attachment points.
Implants too large or too wide: An implant whose base diameter exceeds the breast footprint will push medially into the sternal territory.
Progressive capsule change: The capsule can contract or deform in ways that pull the implant medially over time, even from an initially correct position.
Subglandular placement: Higher risk than submuscular, as there is less tissue between the implant and the sternal skin.
Previous failed correction attempts: Each revision can further damage the limited sternal soft tissue available for anchoring.
Symmastia correction is one of the most technically demanding procedures in revision breast surgery. The goal is to permanently re-establish the medial pocket boundary and re-attach the sternal skin.
Dr. Tachmes' approach includes:
Patients should understand that symmastia correction carries a higher recurrence risk than most other revision types. Long-term success depends on strict post-operative compliance, implant size discipline, and realistic expectations.
This correction demands surgical precision and experience with complex medial pocket reconstruction. Submit your case for Dr. Tachmes' direct personal review and receive an honest assessment of your options.
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