Introduction:

Synmastia after breast augmentation is a condition of aberrant communication of the breasts caused by violation of the chest midline by medial migration of one or both implants. A previous study of synmastia by the authors indicate that subpectoral placement of breast implants is a contributing factor. A number of techniques have been proposed for correction of synmastia including capsulorrhaphy, delayed revision, and capsular flaps. Although an ideal solution for correction is to place the implants in a new site, the subglandular placement is often times undesirable due to lack of breast tissue. We propose a novel technique for site change of subpectoral implants while maintaining subpectoral placement: the neo-subpectoral pocket.

Methods:

Creation of a neo-subpectoral pocket involves developing a plane between the pectoralis major muscle and anterior leaflet of the capsule. A precise pocket dissection is performed similar to a 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 we first employed it in November 2005.

Results:

A total of seven patients underwent synmastia correction using the neo-subpectoral technique. There have been no recurrences of synmastia in these seven patients to date using this technique. The follow-up range is from one to sixteen months, with a mean of 6.7 months. Complications from the correction include one post-op hematoma and one bottoming out of the implant requiring revision.

Conclusions:

Synmastia is a difficult surgical complication to address. The neo-subpectoral pocket technique for the correction of synmastia is a new method that offers 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 most forms of implant malposition, particularly synmastia.