Complicated Symmastia Correction Using Neosubpectoral Approach with Strattice Mesh Reinforcement

Introduction-

Often resulting from excessive medial dissection, symmastia is a deforming complication of breast augmentation that remains challenging to correct [1]. Multiple treatment options have been reported including capsulorrhaphy, adjustable implants, intracapsular allogenic dermal grafts, capsular flaps, and staged repair [1-4]. We present the correction of a complicated symmastia following non-endoscopic transaxillary breast augmentation using a combination of neosubpectoral pocket with medial strattice mesh reinforcement. 

Case report-

An otherwise healthy 29 year old female presented with dramatic symmastia following non-endoscopic transaxillary bilateral saline breast implants. Examination revealed symmastia with evidence of retraction of the right pectoralis major muscle from the medial insertion.  

Treatment-

Preoperative consultation with the patient emphasized the goals of treatment, including correction of the symmastia and prevention of recurrence. The patient was taken to the operating room for removal of the saline implants and creation of a neosubpectoral pocket. The medial capsule was tacked to the chest wall and a strattice mesh was placed between the medial border of the pectoralis major muscle and the medial capsule to create a reinforced sling for the new silicone implant.  

Conclusion-

The combination of neosubpectoral pocket with medial strattice mesh reinforcement improved the correction and prevention of recurrence for complicated symmastia with lateral retraction of the pectoralis major muscle. 

References: 

1. Spear SL, Dayan JH. The “neosubpectoral” pocket for the correction of symmastia. Plast Reconstr Surg. 2009 Sep;124(3):695-703. 
2. Becker H, Shaw KE. Correction of symmastia using an adjustable implant. Plast Reconstr Surg. 2005 Jun;115(7):2124-6. 
3. Baxter RA. Intracapsular allogenic dermal grafts for breast implant-related problems. Plast Reconstr Surg. 2003 Nov; 112(6):1692-6.
4. Voice SD, Carlsen LN. Using a capsular flap to correct breast implant malposition. Aesthet Surg J. 2001 Sep;21(5):441-4.