Congenital Symmastia: A 3-Step Approach

Abstract

Summary:Congenital symmastia is a medial confluence of the breasts. It is a rare anomaly with few reports in the literature and no standard treatment. In this article, we present a case of congenital symmastia treated by 3 steps: liposuction, fixation of the skin to the chest wall in the area of the intermammary sulcus, and postoperative intermammary compression. A successful result was achieved with normal cleavage between the breasts. So, this is considered the ideal treatment for this condition.

Congenital Symmastia

“…The original article by Spence et al 1 describes 2 cases of congenital symmastia, but the discussion by McKissock in the same journal issue states, “I have had a number of these cases… I am certain there must be many hundreds of similar cases in the forgotten files of surgeons across the country….” McKissock then provides images from 3 patients he had previously treated, lending credence to this statement. 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 3–11 . Based on these comments, it seems likely that this is an underappreciated clinical finding and underreported in the literature.…”

“…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.…”

“…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.…”

“…Placing anchoring sutures between the midline dermis and sternal periosteum is by far the most common method described for sternal fixation, with 8 reported cases using this technique to define the intermammary sulcus. 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,[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.…”