Treatment of congenital symmastia can be challenging and could benefit from liposuction of the between the breasts (sternum area). The use of compression gauze and a “t-bra” will help put pressure on that area for improvement in contour.
In general, it may take several procedures to achieve a separation. If the patient with congenital symmastia is also interested in breast implants, there is an option to have breast implants placed as well as the liposuction of the cleavage area in one surgery and then after healing and recovery, proceed with a 2nd surgery to perform internal sutures (capsulorrhaphy) for better definition and contour of the cleavage area. Patients with congenital symmastia must have realistic expectations.
Patient / Surgical Example:
This 26 year old teacher from out of state had been thinking about breast surgery for over 20 years. She and her husband had been searching for the best plastic surgeon who had the confidence to improve her situation. She previously had the Nuss procedure for her pectus excavatum and had a metal bar place across her chest. She also has symmastia with webbing and excess skin of the cleavage area.
The markings below are a “road map” for Dr. Pousti through out the procedure. The “green” area is the skin tenting and the area where liposuction will be performed to achieve more contour. The “red arrows” indicate where the patient wants more fullness from the breast implants.
Dr. Pousti injects tumescent fluid prior to performing liposuction to help with anesthesia and control bleeding during the procedure.
The patient was very unhappy about the skin webbing across the bottom of her chest. She already had a scar across her chest from the Nuss procedure so Dr. Pousti recommended using the same scar and excising the excess skin. The patient was very happy with that option. Below you will see the area where the excess skin was removed completely prior to closure.
Below shows the closure of the wound – the patient with temporary sizers in place to assess size, symmetry and overall results.
Below shows the patient immediately before and after her complicated breast surgery with very nice size and definition. Mentor Smooth Round Ultra High Profile Silicone Gel Breast implants were used… 375cc on right side, 350cc on left side. The breast implants were placed with the use of the Keller Funnel.
Bolster dressing is placed to put pressure on the area where liposuction was performed to help the skin “adhere” back down.