Surgical treatment of symmastia: a systematic review of techniques, outcomes and complications

Abstract Background The term “symmastia” defines a confluence across the mid-sternal line of the breast mounds and subsequent loss of adhesion between sternum and pre-sternal skin. This condition can be congenital or, more frequently, iatrogenic. Despite the number of different treatments published in literature, no systematic review or surgical techniques classification has been attempted in literature. There is therefore a concrete need to elucidate surgical options and propose a treatment algorithm, improving surgical practice and patient's care. Objective This systematic review aims to collect and evaluate the published evidence on surgical procedures to correct symmastia deformities (both congenital and acquired) in order to clearly overview possible treatments and outcomes related to this surgery, providing a surgical classification guide as well. Methods In accordance with the PRISMA guidelines, PubMed database was queried for papers describing symmastia surgical treatment, along with operative indications, outcomes and complications. Results 23 articles and 118 patients were finally included in the review. Four main categories of treatment were identified: dermosternal adhesions, capsulorraphy, neo-pocket creation and muscle repair. Symmastia correction was achieved and satisfactory in 108 of patients, despite varying techniques. Globally, recurrence was the most frequent complication, reported in the 8.5% of cases. Conclusion Symmastia represent a difficult condition to treat and recurrence is a common problem. Because of the low number of patients involved in the studies, it is difficult to make conclusions as to the superiority of one technique over another. However, this review, collecting comprehensively for the first time the surgical knowledge over this topic, could guide the surgeon to choose the best surgical treatment based on nowadays evidence.