Correction of Congenital Symmastia with Macromastia

Congenital Symmastia

“…However, since that time, there have only been 11 additional cases of congenital symmastia reported in the literature, for a total of 16 patients, far fewer than McKissock's estimate of unreported hundreds. [3][4][5][6][7][8][9][10][11] Based on these comments, it seems likely that this is an underappreciated clinical finding and underreported in the literature. In addition to difficulty estimating the incidence of symmastia, it is unclear whether there may be a familial component; at least 1 publication describes treatment of a mother and daughter for this condition, implicating a possible familial link.…”

“…The literature identifies 6 patients having undergone concurrent reduction mammaplasty with symmastia repair or having undergone previous reduction mammaplasty without correction of the symmastia. 1,3,6,7,10 Given the limited data on this condition in the literature, symptomatic macromastia potentially plays some role in symptomatic congenital symmastia, or perhaps accentuates the condition, although this association has not been thoroughly explored. Possible reasons for this include increased midline tension from lateral pull by the breasts worsening already weak sternal attachments to the skin, or patients with macromastia having increased soft tissue volume in the midline as well as the breasts, making this condition more noticeable or symptomatic.…”

“…Since that time, liposuction has been a popular treatment for the midline soft tissue to avoid a direct midline incision, with 7 patients undergoing liposuction as a component of repair. [4][5][6]8,10,11 Although there is the potential for breast tissue to be present in the midline, which may make liposuction more challenging, to date, only 1 publication has reported breast tissue in the midline as part of a resection specimen. 7 Even this is difficult to confirm, because images presented in the article seem to demonstrate normal breast tissue resection as well, to create a larger space between the breasts.…”

“…3,4,[6][7][8][9][10][11] For the cases that specify the type of suture used, polydioxanone was the most common, and 1 surgeon reported using nylon suture for internal fixation. 3,4,[8][9][10] Methods of suture fixation vary but generally involve placing 2 rows of quilting sutures to create separate medial breast borders, with varying amounts of skin dimpling accepted depending on surgeon preference. 3,4,[6][7][8][9][10][11] Less commonly, surgeons have reported other methods to help the midline skin adhere to the sternum.…”

“…3,4,[8][9][10] Methods of suture fixation vary but generally involve placing 2 rows of quilting sutures to create separate medial breast borders, with varying amounts of skin dimpling accepted depending on surgeon preference. 3,4,[6][7][8][9][10][11] Less commonly, surgeons have reported other methods to help the midline skin adhere to the sternum. The second most common method was closed-suction drain placement within the intermammary sulcus to help eliminate dead space, with 3 patients reported to have drains placed in the current literature.…”