Symmastia ('Uniboob') Repair
An expert breast surgeon and one of the world's leading authorities on symmastia, board-certified plastic surgeon Dr. Clayton Moliver performs symmastia ('uniboob') repair surgery at his Houston, TX, practice for women from throughout the U.S. and the world. Symmastia repair surgery creates a separation between the breasts, improves the shape of the breasts, restores the cleavage, and enables women to feel more confident in their bodies.
Why Dr. Moliver Is the Best Choice for Your Symmastia Surgery
- DECADES OF EXPERIENCE
- PIONEERING RESEARCH AND INNOVATION
- RESPECTED AUTHORITY ON SAFETY
- EXCEPTIONAL TECHNIQUE AND AESTHETIC RESULTS
Featured Symmastia Transformations
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International Authority on Symmastia
Years of breast enhancement surgery experience
Cosmetic breast surgeries
Symmastia repair and implant malposition cases
Helps symmastia patients from across the U.S. and around the world
What Is Symmastia?
Most people aren’t familiar with the word symmastia—even women who have the condition. The phrase “uniboob” is more commonly used to describe the condition because the breasts sit too close together, resulting in a lack of distinct cleavage between the breasts. Often misspelled “synmastia,” symmastia is a complication that occurs after breast augmentation with or without a breast lift. More than 95% of women with symmastia develop the condition after cosmetic breast surgery. It also occurs rarely as a congenital issue—meaning someone is “born with it”—although it only becomes evident after puberty. This condition is congenital symmastia.
What Causes Symmastia After Breast Augmentation?
Dr. Moliver has devoted much of his career to researching what causes symmastia and developing the best surgical techniques for repairing the condition. His research led to a 2019 study published in the Aesthetic Surgery Journal, finding that while still a rare event, the majority of acquired symmastia occurs in breast augmentation patients where the implant is placed submuscular.
In some patients, this submuscular placement causes the muscle to tear loose from the sternum, pushing up the skin between the breasts. With the muscle torn loose at the sternum, the skin of the sternum has nothing to tether it down to the bone and the skin now lifts up easily, either on its own or when the breasts are pushed toward the midline. Without an intact pocket, the implants move across the chest’s midline and create a uniboob appearance.
In some cases of symmastia, only one side of the chest muscles becomes detached. The implant on that side moves toward the midline of the chest, resulting in the same uniboob appearance—or, at the very least, a very medially displaced implant on the affected side.
Besides placing implants under the muscle, other risk factors associated with acquired symmastia include the following issues:
- The surgeon isn’t meticulous enough when creating the implant pockets on the inner sides of the breasts, so the implants sit too close to the center of the chest. This can occur if the surgeon is trying to create more cleavage.
- The patient is thin or has weak tissue.
- The implants are too large for the patient’s anatomy or the quality of their breast tissue.
Candidates for Symmastia Repair
Symmastia, whether congenital or occurring after breast augmentation, is rare. In some cases, women aren’t aware that they have the condition. Women who consult with Dr. Moliver for symmastia repair want to fix one or more of the following concerns:
- There is no space between the breasts because the implants have shifted to the midline of the chest.
- The skin between the breasts is elevated (like a tent) or lifts when the breasts are pushed together instead of lying flush against the sternum.
- The nipples point toward the arms instead of forward.
- The implants lie below the breast crease. (This is called bottoming out.)
- Fat and breast tissue have formed between the breasts.
Soon after breast augmentation, you may experience swelling, which is a normal side effect of surgery. However, it should not feel as if the skin has lifted away from your sternum. If you have some swelling over your sternum, it should go down within a week. If it stays up, you probably have symmastia, which must be repaired.
‘Couldn’t Be Happier With the Outcome’ “Couldn’t be happier w the outcome of my breast reconstruction repair. Pain management was wonderful. Dr Moliver was kind and compassionate and there for every step. The ladies who work in the office are helpful and responsive. I will def be returning in the future.”
-September 2023 RealSelf review
Symmastia Repair
As one of the world’s leading symmastia experts, Dr. Moliver sees patients from throughout the U.S. and the world for symmastia repair surgery. He creates a custom surgical plan based on the patient’s specific needs, performing the operation as an outpatient procedure while the patient is under general anesthesia. Dr. Moliver’s goal during symmastia repair surgery is to return the chest muscle and the breast tissue to their original anatomic position.
During symmastia repair surgery, Dr. Moliver may revise the breast implant pocket, reattach the chest muscle to the sternum using sutures, and insert smaller implants if necessary. He places implants over the muscle and may use fat grafting to camouflage the surface and/or edges of the implants for patients with minimal breast tissue.
Incisions
Whenever possible, he makes incisions in the same location as the original breast augmentation incision to avoid creating additional scarring. If the original incision was made on the edge of the areola (periareolar), however, Dr. Moliver favors making a discreet incision at the base of the breast (inframammary) because periareolar incisions are linked to more frequent incidents of capsular contracture.
Complication Repair
Symmastia repair surgery also often addresses complications associated with symmastia, such as bottoming out, skin webbing, oversized implant pockets, and other unattractive breast shapes.
Internal Mesh
Dr. Moliver no longer uses internal mesh or acellular dermal matrix during the procedure because his research and clinical experience showed that it’s not necessary and may contribute to the complication’s recurrence.
Correcting Previous Repairs
Almost two-thirds of the symmastia patients he sees have undergone one or more unsuccessful repair surgeries elsewhere. Even though the best symmastia repair candidates haven’t undergone previous repair procedures, Dr. Moliver can completely repair or improve the appearance of a patient’s breasts regardless of the number of previous repair attempts performed by other surgeons.
What Is Pseudo-Symmastia?
In some cases, Dr. Moliver performs symmastia repair surgery for patients with a condition he has come to call pseudo-symmastia. This isn’t the result of improperly placed implants or rupture of the sternal attachment of the pectoralis muscle. Instead, these patients usually have loose skin on the sternum before undergoing a breast lift or breast reduction, and the result of the procedure creates the “uniboob” appearance. This complication can be more difficult to repair but can often be fixed.
How Long Is Recovery After Symmastia Repair?
Recovery time for symmastia repair is much like a breast lift or other type of breast surgery. Dr. Moliver instructs patients to avoid any heavy lifting or other physical activity for 6 to 8 weeks that could result in the chest muscle detaching from the sternum.
Dr. Moliver closely manages his symmastia repair patients’ recovery because they must limit arm movements by keeping their arms at their sides. Patients wear a surgical bra during their recovery, often with extra padding over the sternum. Patients should limit arm movements and wear these bras for 6 to 8 weeks before gradually resuming more extensive motion.
An Educator and Mentor
Dr. Moliver's love of artistic creativity and natural scientific curiosity led him to become one of the world's top cosmetic and reconstructive breast surgeons and a renowned symmastia expert. He has published groundbreaking, peer-reviewed articles on the treatment of symmastia, a complication that can occur if the muscle attachment to the sternum is over-dissected or if the patient was born with a very tiny attachment of their muscle to the sternum. When an implant is placed under the muscle, these skinny muscles simply rupture. This can be spontaneous from just the augmentation, or the risk can be exacerbated by over dissection or implants that are too large.
He's a clinical editor for the Aesthetic Surgery Journal, the largest aesthetic surgery journal in the world.
“I would have to say that my career-defining operation/technique/niche is symmastia … I have done a lot of research with residents to help define exactly what is going on and have published several papers on it. I see a lot of patients who are referred to me from out of state or out of the country for symmastia repair. I see breasts that have been operated on 4 or 5 times by other physicians that need to be revised and corrected.”
-Dr. Clayton Moliver
Training Under World-Famous Mentors
Dr. Moliver trained for 2 years under 3 of the world’s most famous plastic surgeons at the prestigious Cronin, Biggs, and Brauer Clinic. Dr. Thomas D. Cronin is recognized as the co-inventor of the modern breast implant, which helped lead Houston to become a destination for breast augmentation surgery.
Teaching Plastic Surgery’s Next Generation of Surgeons
Throughout his career, Dr. Moliver has shared his vast knowledge of cosmetic and reconstructive surgical techniques with plastic surgery residents and practicing plastic surgeons.
Dr. Moliver’s academic appointments include:
- Clinical Professor, Division of Plastic Surgery, The University of Texas Medical Branch
- Participation and Regular Attendance, Plastic Surgical Residency Journal Club of University of Texas Medical Branch, Department of Plastic Surgery
Safety Is the Priority
Dr. Moliver was among the first plastic surgeons in the Houston area to create an operating room at his practice 25 years ago. The OR is accredited by Quad A (formerly known as the American Association for Accreditation of Ambulatory Surgery Facilities), the gold standard for safety. His involvement in breast implant safety extends throughout his career. For example, he has never used textured implants, some of which have been linked to a rare form of lymphoma and taken off the market. In all that he does, Dr. Moliver places your safety and health at the forefront.