Pseudo-Symmastia and Breast Augmentations

MTF/N breast augmentations are a great way to help trans women and feminine-spectrum non-binary and gender-diverse individuals increase their experiences with embodied gender euphoria. However, there are risks of symmastia and pseudo-symmastia with breast augmentations.

What is symmastia?

One of the risks is symmastia, defined as a joining of the breasts in the middle of the chest. Symmastia, when present, means that there is minimal or no visible cleavage or flatness in the center of the chest between the breasts. In the context of plastic surgery, symmastia is usually considered to be a result of an error made by the surgeon. Therefore, we highly recommend that patients choose a Board-certified plastic surgeon to perform their gender affirming breast augmentation.

The left image shows flatness, or a cleft, between the breasts. The right image shows breasts without any separation, otherwise known as symmastia. Individuals with symmastia have no visible cleavage or flatness in the center of the chest between the breasts.


Another possible complication as a part of breast augmentation procedures is pseudo-symmastia. Pseudo-symmastia happens when the implants are placed correctly but they are so big that they stretch the skin in the middle of the chest. Similar to symmastia, patients who experience pseudo-symmastia also see less of a flat cleavage area between the breasts. This phenomenon is called pseudo-symmastia because it’s related to skin stretching between the breasts rather than implant placement.

Above image shows a top view cross section of breasts without symmastia (top image) and breasts with symmastia (bottom image). Without symmastia, there is space between the breasts creating a cleft and a level of flatness between the breasts. The bottom image shows true symmastia where the capsules are joined, leaving no cleft between the breasts. Individuals experiencing pseudo-symmastia, however, present joined breasts. This is a result of the skin pulling too tightly and being unable to lay flat on the chest in the space between the breasts. The fascia which normally keeps the skin connected to the sternum has been disconnected. With pseudo-symmastia, the capsules are not joined but the addition of the implants pulls the skin away from the chest.

Limits on Breast Implant Size

When considering the implant size appropriate for each patient, the surgeon must weigh the possibility of symmastia and pseudo-symmastia. Because of the risk of pseudo-symmastia, it’s not always possible for patients to get their ideal results, especially if they have a very tight and flat chest before surgery. This means that on occasion, patients may have to have implants with less volume in order to avoid the risk of symmastia and pseudo-symmastia.

For some patients who experience pseudo-symmastia, there is the chance that a second augmentation can be performed after the skin in the chest area has relaxed and healed after surgery. However, because this is not always a possibility for all patients, Dr. Mosser will make recommendations about implant size based on how flat and tight a patient’s chest is before surgery.

Contact us to learn more about symmastia, pseudo-symmastia, and other risks and complications associated with a MTF/N breast augmentation.