We have noted that the midsternal fascia is a dense, strong, whitish structure that measures approximately 3 mm in thickness and in height. It attaches firmly the midsternal skin to the underlying sternum as shown schematically in Figures 1 and 2.
We also propose subdividing symmastia after breast augmentation into two groups: bicapsular symmastia (Fig. 1) when some muscle fibers and/or soft tissue connect the midsternal skin to the underlying sternum on one side (Fig. 1, left), and monocapsular symmastia when there is communication between the two periprosthetic capsules (Fig. 2). The degree of symmastia is generally moderate in bicapsular symmastia (Fig. 1), and its correction is simpler because the repair of the more advanced side (Fig. 1, right) generally corrects the deformity. In the case of monocapsular symmastia, when the degree of symmastia is generally severe (Fig. 2), both sides require surgical correction.
Symmastia must be differentiated from medial malposition, with which it is commonly confused. We reserve the term “medial malposition” in all instances when the midsternal fascia remains intact. To avoid symmastia and medial malposition of the implants, we have found that gentle blunt dissection of the pockets medially under direct vision preserves the relatively thin and dense midsternal fascia and also minimizes the occurrence of medial malposition resulting from overzealous dissection of the medial fibers of the pectoralis muscle.
Fereydoun Don Parsa, M.D.
Shannon D. Koehler, M.D.
Alan A. Parsa, M.D.
Daniel Murariu, M.D., M.P.H.
Prester Daher, M.D.
John A. Burns School of Medicine
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2. Spear SL, Bogue DP, Thomassen JM. Synmastia after breast augmentation. Plast Reconstr Surg.
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3. Spear SL, Dayan JH, Bogue D, et al. The “neosubpectoral” pocket for the correction of symmastia. Plast Reconstr Surg.
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