Correction of post-surgical synmastia after stepwise treatment of pectus excavatum and breast asymmetry-A case report.

We present a case of a 30-year-old female patient requiring correction of post-surgical synmastia after stepwise treatment of pectus excavatum (funnel chest) and breast asymmetry (right < left). The funnel chest was first corrected with a 3D custom-made implant, placing the cranial part of the implant in a sub-muscular pocket. Asymmetric breast hypotrophy was corrected by means of subfascial breast augmentation one year later. During follow-up, synmastia developed due to the lack of soft tissue interface between the distal part of the custom-made thoracic implant and the breast implants. Corrective surgery exposed the subjacent sternal periosteum excising a central wedge of the custom-made implant, allowing for quilting sutures between breast skin and periosteum to reconstruct the intermammary fold. Breast asymmetry was corrected using different implants that were hold in place by a synthetic mesh, acting as an inner bra. At the 1-year follow-up, breast symmetry was observed with a preserved intermammary fold.