Familial congenital symmastia: Ultrastructurally abnormal breast tissue

Abstract

Reports about congenital symmastia and its surgical treatment are few. We report two patients - a mother and daughter - with congenital symmastia in whom breast and fatty tissue was found to be mobile adhering poorly to the chest wall. Although histological examination showed no abnormality of the tissue bridge between the breasts, ultrastructural investigation of breast tissue (including Cooper's ligaments) showed an abnormal arrangement of collagen fibres. Satisfying aesthetic results were achieved by resection of excess soft tissue in the cleavage area through a submammary incision and fixation of the skin with subcutaneous interrupted sutures to the sternal periosteum.

Congenital Symmastia: A 3-Step Approach

“…These sutures can be inserted through small inframammary fold incision, 5,7,8 as in our presented case, periareolar incision, 3 or vertical scar mammoplasty incision. 4 However, the inframammary incision gives superior cosmetic result as it is less visible.…”

“…Piza-Katzer et al 5 reported 2 cases of congenital symmastia in a mother and a daughter, and they found the abnormal arrangement of collagen fibers in the breast tissue (including Cooper’s ligament) in both cases, and so, they assumed that this condition may have a familial cause.…”

“…First is the removal of the excess tissue between the 2 breasts. This is achieved either with surgical resection 5,7 or with liposuction 2,3,6–8 as in the case presented in this study. The use of liposuction only was reported to give successful result by 1 study, 6 but in another study, 7 the correction was insufficient, and a second procedure was performed with resection of the glandular-fatty tissue in the cleavage and suturing the skin to the chest wall.…”

“…Second is to fix the skin of the intermammary sulcus to the underlying periosteum with sutures either at the midline 3,4,8 or at the lateral sternal border 5,7 as in our case presented here. These sutures can be inserted through small inframammary fold incision, 5,7,8 as in our presented case, periareolar incision, 3 or vertical scar mammoplasty incision.…”

Correction of Congenital Symmastia with Macromastia

“…[23] This web-like soft tissue is composed of glandular tissue, subcutaneous fat, and fibrous septa in different proportions, which traverses the sternum to connect both breasts medially. [1245] Only a few case reports of congenital symmastia have been previously reported, and the knowledge of its pathophysiology, exact incidence, and ideal treatment is still insufficient. [23] Herein, we present a case of congenital symmastia with macromastia corrected with liposuction and reduction mammoplasty with good esthetic results.…”