INTRODUCTION: Synmastia can be a challenging problem to correct. A number of techniques have been proposed including removal of the implants with delayed revision, adjustable implants, and capsulorrhaphy. Each of these options has drawbacks in terms of reliability, difficulty, or convenience. An ideal solution would be placing the implant in a new site. However, if the implant is already in the subpectoral position, this would require subglandular placement which may be undesirable. A new technique is described whereby a neo-subpectoral plane is created between the pectoralis major muscle and the anterior leaf of the existing capsule. Thus, the benefits of a subpectoral position are maintained while a new and precise pocket dissection may be performed in a different site. METHOD: Creation of a neo-subpectoral pocket involves developing a plane between the pectoralis major and the anterior capsule. A precise pocket dissection is performed similar to a primary breast augmentation in this virgin plane. The technical details of this new procedure are described. A chart review was conducted on all patients who underwent synmastia correction using this technique since it was first employed by us in November 2005. RESULTS: A total of six patients underwent synmastia correction using the neo-subpectoral technique. Several of these patients presented for recurrence after failed capsulorrhaphy. There was no recurrence of synmastia to date in this study. The follow-up range is from one to fifteen months. One post-op hematoma occurred. Three patients had their implant size reduced, two patients had larger implants placed, and one patient remained the same size. CONCLUSION: The neo-subpectoral technique for the correction of synmastia is a new method that may offer an effective solution in a single stage. We have also applied this technique successfully in the treatment of capsular contracture and other difficult revisions. It is an appealing concept that allows for a site change while maintaining the subpectoral position and further reinforcing closure of the old capsule. This procedure is technically straightforward, and offers a useful means of correcting all forms of implant malposition.

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