Congenital symmastia or possible result from early heart surgeries? (Photos)

Thank you for your question. It’s understandable to feel anxious ahead of a major consultation. Based on having had three heart surgeries as an infant and now noticing symmastia, it is very possible that what you're experiencing is acquired symmastia rather than congenital. Acquired symmastia can occur from surgical disruption of midline tissues related to median sternotomy or scar tissue formation from your early cardiac surgeries. However, since you're preparing for a prophylactic mastectomy, your breast surgeon can assess this intraoperatively. If there is true symmastia, they can reconstruct the natural cleavage plane during the mastectomy and reconstruction. Your consultation will give you definitive answers, but you are not alone, and this issue is surgically manageable.

Thank you for your pictures and questions. Sorry to hear about the diagnosis but at least you are being proactive and taking care of things early. Most likely, if your underlying bony anatomy is normal (no pectus deformity or something along those lines), the symmastia you have is as a result of the pediatric surgical procedures. When the soft tissue is lifted off the sternum (breastbone) and those attachments are severed, that tissue is never the same and stay elevated off the bone as the breast develops. The good thing here is that in speaking with your reconstructive plastic surgeon, you can talk about the new breast you want to create and how to correct this problem. Once the entire breast is removed, it is the plastic surgeon's job to create a new breast and attempt to correct any pre-existing deformities or any that occurred during the mastectomy (over-dissection of the soft tissue for example). Using a combination of biologic or synthetic mesh along with suture techniques, it is often possible to correct or at least improve symmastia significantly. It can be a difficult repair with a moderate failure rate, but it can certainly be improved, if not corrected completely. Ask your surgeon how he or she prefers to correct these types of problems and I am sure they have an algorithm that works for them in the past. I will also include a link to the ThongBra which is a post-op central compression bra that I find helpful for patients to wear to aid in repair of these types of issues. Hope this helps! Best of luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL