One of the rare congenital breast conditions is symmastia. This condition is where the two breasts converge across the sternum eliminating the cleavage area and replacing it with the inner halfs of the breast mounds or a webbing. The name comes from Greek word derivation combining syn (together) and mastos. (breast)
While it is a well known complication from breast augmentation though disruption of the medial edges of the pectoralis muscle, as a congenital deformity it is very rare. Few cases have ever been reported and as a result no standard surgical treatment exists.
In the December 2016 issue of the journal Plastic and Reconstructive Global Open issue a paper was published entitled ‘Congenital Symmastia – A 3 Step Approach.’ In this described technique Liposuction was performed in the presternal area and the web between the breasts but was not extended beyond the lateral border of the sternum. An inframammary fold incision was made just 3 cm lateral to the midline of the sternum. Three quilting sutures were inserted in the intermammary area on each side of the midline between the dermis of the presternal skin and the periosteum at the lateral sternal border. After surgery a compression bolster was applied to the intermammary sulcus for several months on a continuous basis.
This approach to congenital symmastia correction includes three specific surgical manuevers. First excess subcutaneous tissue is removed between the two breasts which is most easily done with liposuction. Secondly the skin of the intermammary sulcus must be fixed down to the underlying periosteum by sutures either at the midline or at the lateral sternal border through the inframammary fold incision. It is almost always easier to place them at the lateral sternal border. The last step is postoperative compression for which there is no exact device/garment made for it. Various bolsters or bra modifications have to be devised.
Dr. Barry Eppley
Indianapolis, Indiana