02/16/2026
Let’s Discuss Symmastia 👨⚕️
So what about primary versus secondary?
This is some terminology that’s come up in the literature recently for symmastia. I like calling it either congenital or acquired. Congenital meaning primary—and that’s when a young lady hits puberty and the breast tissue starts growing and it lifts off the skin of the chest in the midline, in the sternal zone of adherence. That’s primary, or congenital.
And then there’s acquired, which means it happens later, usually in response to something. We’re seeing lots of different variations on how this can happen. Overwhelmingly, the most common acquired, or secondary, symmastia is secondary to a breast augmentation—most of the time under the muscle—that ruptures the muscle where it comes off the sternum on one side or both, in the bottom or the bottom and the top on each side, or that kind of thing. That’s acquired symmastia.
Many times, we also see acquired symmastia secondary to large breasts that are pendulous. That causes shear and causes the skin to slowly pull off. We also see it in very, very overweight patients, and when they eventually get their reduction or their lift, that kind of thing, it shows up. As the breast is tightened and lifted, the skin now lifts off.
It’s always been loose, but now it becomes obvious—and that’s what we call secondary, or acquired, symmastia. Either secondary to a breast augmentation, breast reconstruction, or it becomes apparent when the loose skin gets lifted after a reduction or lift.
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