An efficient method for the correction of iatrogenic symmastia: A case series.

BACKGROUND: Symmastia is a medial confluence of the breasts, produced by a web of skin and fat merged across the midline, that generates the disappearance of the intermammary sulcus. Apart from the rare congenital cases, this condition is usually a result of technical complications during breast augmentation surgery.This article describes a simple and reliable method for correcting symmastia. METHODS: From November 2006 to June 2015, we treated 10 patients with acquired symmastia who had previously undergone an implant-based reconstruction. We performed a crescent-shape medial capsulectomy and we then performed an adequate and resistant closure with a substitute device, consisting of a Tuohy epidural needle and polydioxanone sutures, which are easily accessible and inexpensive. The process outcome was successful and resulted in a normal cleavage between the breasts. RESULTS: Mean follow-up was 24 months. We haven't observed any recurrence of symmastia to date in this study. One postoperative hematoma and one seroma occurred. All ten patients achieved acceptable results through the procedure. CONCLUSION: Our pericapsular Tuohy technique for medial closure of the pocket is a practical and efficient substitute to traditional capsulorraphy and provides reliable and reproducible results.

Prevention of Synmastia in Breast Augmentation of Sunken Chest: Muscle Splitting Concept

BACKGROUND: Synmastia is serious condition but rare. Synmastia is a technical complication caused by over dissection of the medial pocket over the sternum. In sunken chest, the medial portion of Pectoralis muscle tends to be elevated easily from the sternocostal area. So it should be more careful to prevent from overdissection in breast augmentation of sunken chest. METHODS: An idea was obtained from buttock augmentation with implant. For buttock augmentation, implants are placed intramuscularly for the protection of sciatic nerve and for the prevention of implant displacement. Muscle splitting concept for intramuscular placing of implant in sunken chest adds tissue to sunken area and provide guarding barrier to reduce detaching tendency at the parasternal area. RESULTS: As I had the concept of intramuscular placement at the medial side for the breast augmentation in case of sunken chest, I experienced steady medial breast contour in 5 cases of sunken chest. CONCLUSIONS: Muscle splitting as coronal plane of medial portion of pectoral muscle make muscular pouch at the medial corner of subpectoral pocket which is effective for the prevention of medial displacement of implant in breast augmentation of sunken chest by guarding effect of irregularly arranged muscle fibers which resist against the detaching force of pectoral muscle from the sternocostal origin.