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Outcomes of Surgical Treatment of Symmastia
Anthony DeLeonibus, BS; Vahe Fahradyan, MD; Antonio Rampazzo, MD, PhD; Bahar Bassiri Gharb, MD, PhD
Cleveland Clinic
2018-02-11
Presenter: Anthony DeLeonibus
Affidavit:
This is the medical student's, Anthony DeLeonibus' original work and he was involved in all steps of this study.
Director Name: Bahar Bassiri Gharb, MD, PhD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction:
Symmastia is an anterior chest wall deformity that presents with medial presternal confluence of the breasts originating from developmental (DS) or iatrogenic factors (IS). Outcomes of the surgical management of symmastia are not well reported. The aim of this analysis was to evaluate the available surgical techniques for IS and DS in order to provide evidence-based treatment recommendations.
Methods:
A systematic review was performed utilizing the online search databases, Pubmed, Medline, and Embase according to PRISMA guidelines for parameters including age, gender, surgical indications, approach, complications, recurrence, and follow-up.
Results:
Out of 112 total reported cases, 97 (86.6%) were IS and 15 (13.4%) were DS. The most common surgical approaches for IS were neosubpectoral pockets with the obliterated capsule serving as the posterior-medial support (n = 48, 49.5%), insertion of acellular dermal matrices along the medial pole for midline repair (n = 17, 17.5%), and capsulorrhaphy/capsulodesis along with modification of the pocket plane (n = 14, 14.4%). The most common surgical approaches for DS were liposuction, transdermal-sternal periosteal sutures (n = 9, 60.0%), and post-operative compression garments (n = 8, 53.3%). Recurrence was associated with muscle splitting technique in IS (n = 2, p < 0.05) and presternal web resection in DS (n = 2, p = 0.776).
Conclusion:
Iatrogenic symmastia is the most common form of symmastia with an increasing incidence associated with the growing desire of breast augmentation in the general population. IS is best treated with neosubpectoral pockets while DS requires liposuction and transdermal-sternal sutures.
