What symmastia actually is
Symmastia (also called "uniboob," "breadloafing," or "kissing implants") is a breast augmentation complication where the implants drift toward each other across the chest's midline, eliminating the natural cleavage gap. Mild cases create a flat, undefined sternal area. Severe cases produce a single continuous bulge across the chest.
It can be congenital (born with it, very rare) or acquired (after augmentation, most cases). Roughly 1–3% of augmentation patients develop some degree of symmastia, with risk concentrated in patients with oversized implants, weak chest tissue, or surgeons who over-dissect the medial pocket.
Why it happens after surgery
The implant pocket is created surgically. The medial wall of that pocket — the connective tissue keeping the implant away from the midline — is thin. If a surgeon dissects too aggressively medially trying to maximize cleavage, the medial walls of both pockets can join, creating a single space. The implants then float into the middle.
Risk factors:
- Implants too wide for the patient's chest (oversizing)
- Aggressive medial dissection during initial surgery
- Thin native tissue (low BMI, hypoplastic chest)
- Subglandular pocket (over the muscle) instead of submuscular
- Capsular contracture pulling tissues inward
Korean repair techniques
Korean revision specialists have developed several approaches. Choice depends on severity:
Capsulorrhaphy with internal sutures
The medial capsule is reinforced with non-absorbable sutures, recreating the missing midline barrier. Often combined with implant downsizing.
Acellular dermal matrix (ADM) reinforcement
A sheet of processed donor dermis is placed along the medial pocket wall to physically reinforce the tissue. More expensive (₩2–4M added cost) but durable.
Pocket conversion
If the original pocket was subglandular, conversion to submuscular (under pectoralis muscle) places the implant behind a stronger anatomical barrier.
Implant exchange + downsize
Often the simplest fix: remove the oversized implants, allow tissues to recover for 3 months, then re-augment with smaller implants and proper pocket dissection.
Recovery from symmastia revision
- 1–2 nights hospital stay typical
- Compression bra worn 24/7 for 6 weeks
- Specialty "thong-style" bra with central column to maintain midline gap
- Return to desk work: 7–10 days
- Full physical activity: 8–12 weeks
- Final shape: 6 months
Cost
Gangnam revision: ₩8–15M ($6,000–11,500), depending on complexity and whether ADM is used. International patients often pay 30–50% more for primary surgery in their home countries; the revision cost ratio is more favorable in Korea.
Honest framing
Symmastia revision has a real recurrence rate (10–20% even with experienced surgeons) because the underlying anatomy that caused it the first time often persists. Patients should accept that the revision goal is "improvement" rather than "perfection," and should plan for the possibility of a second revision. Choose surgeons with documented revision experience — this is not a procedure for general augmentation specialists, and red flags include surgeons who minimize the difficulty or guarantee specific results.