Abstract
Symmastia, the medial confluence of breast implants producing a ‘bread loaf’ quality, has continued to be a vexing complication of breast reconstruction and breast augmentation, despite numerous proposed repair methods. Previous procedures include capsulorrhaphy, allograft or xenograft sling suspensions, mastopexies and, in cases of subglandular implants, collapsing the pocket and reinserting the implant beneath the pectoralis major muscle. In the present article, the authors outline a reliable long-term correction of submuscular symmastia, combining the techniques of capsulorrhaphy, use of porcine xenograft slings, submuscular placement of the implants, and use of capsular tissue folded and sutured onto the presternal fascia with nonabsorbable sutures. This technique places the porcine xenograft sling between the implant and the folded capsular tissue sutured with nonabsorbable sutures, protecting the implant from erosion/puncture by the nonabsorbable sutures. The authors also propose a similar technique for the correction of subglandular symmastia.
The patient in the current article presented with submuscular symmastia and has been followed for <4 years postoperatively with absolutely no recurrence of symmastia, even with forcible application of lateral pressure on her breasts in an attempt to reproduce medial confluence. The technique offers a promising solution to the frustrating difficulty of symmastia, a complication with a high recurrence rate despite many proposed repairs across decades.