Correction Of Synmastia Using The Neo-subpectoral Pocket: Technical Refinements For Difficult Cases
Joseph Dayan, MD, Scott L. Spear, MD, David P. Bogue, MD, Mark Clemens, MD, Steven A. Teitelbaum, MD, and G. Patrick Maxwell, MD.
following subpectoral breast augmentation can be a difficult problem. Numerous
techniques have been reported with varied results including capsulorrhaphy,
delayed revision, and adjustable implants. Each of these options has drawbacks
in terms of reliability, technical difficulty, and convenience for the patient.
of repairing an already deformed pocket, an ideal solution would be to create a
new pocket in a different site. The neo-subpectoral technique is described
whereby a new pocket is dissected between the pectoralis major muscle and the
anterior surface of the implant capsule. Thus, the benefits of a subpectoral
position are maintained while a precise pocket dissection may be performed in a
new site. The purpose of this study is to evaluate the effectiveness of this
technique along with the use of adjuncts such as acellular dermis.
The creation of a
neo-subpectoral pocket involves a precise pocket dissection just deep to the
pectoralis muscle but superficial to the anterior surface of the capsule. For
patients who had multiple prior treatment failures, a sheet of acellular dermis
was used to bolster the repair. The technical details of this procedure are
described. All patients with synmastia were evaluated since this technique was
first used at Georgetown University Hospital in November 2005.
underwent synmastia correction using the neo-subpectoral technique. Three of
these patients presented to us with recurrent synmastia after previously failed
attempts at correction using capsulorrhaphy. Acellular dermis was used as an
adjunct in three patients. There was no recurrence of synmastia to date in
this study. Follow-up ranged from 1.5 to 27 months with a mean follow-up of
11.5 months. There was one hematoma that required evacuation.
technique is an effective method for the correction of synmastia and many types
of implant malposition in a single stage. Acelluar dermis may also be used
successfully as an adjunct to the neo-subpectoral technique in difficult
revisions. This procedure is technically straightforward with stable results
on long-term follow-up.