03/09/2026
Let’s Discuss Symmastia 👨⚕️
What should your expectations be after a symmastia repair?
I classify them as level one, level two, or level three, and really this is dependent on how many surgeries for symmastia you’ve had. If you’ve had six or seven surgeries, it’s a level three. It’s much, much more complicated, and there’s a bit higher chance of recurrence—ten to twenty percent.
A primary, early, level one symmastia is, for example, a young lady twenty to thirty-five who had a single breast augmentation, maybe a change-out of implants for some reason, and they immediately had elevation of their skin of their sternum postoperatively. Typically they’re told, “Oh, it’s swelling, it’ll go down”—very rarely.
So the expectation should be that with a primary breast augmentation and only one surgery, maybe two, and implants that have never been placed over the muscle, repairing the muscle should drag the skin back down and that should be it, and you should have a good repair that lasts.
Sometimes with recurrent symmastias, or symmastia repairs that keep on failing, you’ll have a very, very nice improvement in your sternal skin in terms of where it is and how we got it to sit down, but sometimes there’s still a little bit of elevation—maybe one or two centimeters—that we just can’t fix without getting in there and sewing skin down. That requires a lot of dissection, or sometimes an approach from underneath the xiphoid, an incision down here, to go all the way up and sew the skin down that way.
Very often we can get a nice crease, we can get the skin to sit down, and if we’re sewing from both sides of the muscle, we can get a nice width to the sternal skin. Sometimes when the skin is totally disrupted, we can only sew the skin down, and sometimes we can just get a very narrow cleavage adherence area—but it’s still so much better than what they had before. They’re usually pleased with it.
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