Iatrogenic symmastia is difficult to treat and recurrence is common. Correction requires combined restoration of the presternal subcutaneous integrity and medial closure of the pocket. In our case, we removed the implants and performed a combination of medial closure of the pocket on each side and transcutaneous suturing of the presternal soft tissue to the sternum periosteum. The prostheses were implanted during the same stage. It is essential that oversized implants not be used. The tension of the implant must not be allowed to work against the suture repair. Several other methods have been described for surgical reconstruction of iatrogenic symmastia, such as allogenic dermal grafting,2 fibrin-based tissue glue,3 and delayed filling of the adjustable implant.4 Even though it has been reported that transcutaneous fixation may lead to scarring and infection,5 in our hands, the combination of medial closure of the pockets and transutaneous suturing of the presternal soft tissue to the sternum periosteum was successful. It led to reconstruction of the presternal median cleavage without parasternal scarring or infection. The result was judged satisfactory by both the patient and the surgeons. The combination of medial closure of the pockets and transcutaneous suturing of the presternal soft tissue to the sternum periosteum provides one satisfactory option to the surgical reconstruction of iatrogenic symmastia.
Andreas Foustanos, M.D.
Harris Zavrides, M.D., Ph.D.
Neither author has any financial interests in this communication.
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