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

  • D. Guillier
    Affiliations
    Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery - University Hospital, Boulevard de Lattre de Tassigny, F-21000 Dijon, France
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  • G. Sapino
    Affiliations
    Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Rue du Bugnon 46, 1011 Lausanne, Suisse

    Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Largo del Pozzo 71, 41100 Modena, Italy
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  • W. Watfa
    Affiliations
    Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Rue du Bugnon 46, 1011 Lausanne, Suisse

    Department of Plastic and Reconstructive Surgery, Saint George University Hospital of Beirut, Beirut, Lebanon
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  • W. Raffoul
    Affiliations
    Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Rue du Bugnon 46, 1011 Lausanne, Suisse
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  • PG di Summa
    Correspondence
    Corresponding author.
    Affiliations
    Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Rue du Bugnon 46, 1011 Lausanne, Suisse
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Published:September 20, 2020DOI:https://doi.org/10.1016/j.bjps.2020.08.138

      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 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed database was queried for papers describing symmastia surgical treatment, along with operative indications, outcomes, and complications.

      Results

      In this review, 23 articles and 118 patients were finally included. Four main categories of treatment were identified: dermo-sternal adhesions, capsulorrhaphy, neopocket 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.

      Keywords

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