Less Common Complications
In synmastia, a rare but serious complication, the breasts become conjoined because the natural intermammary sulcus (the cleft between the breasts) is obliterated. Causative and contributing factors include aggressive medical resection of the breast, medial migration of either or both implants, selection of a breast implant that is too large for the chest wall, a history of multiple breast surgeries, and a chest wall deformity called pectus excavatum.34 Treatment for synmastia is generally surgical. The main goals of surgical treatment are restoration of the initial presternal subcutaneous integrity and medial closure of the pocket.34,35
Bottoming outsimply means descent of the breast implant on the chest wall sufficient to compromise the inframammary fold. Early bottoming out is most likely due to overdissection or insufficient dissection of the implant pocket, whereas later occurrence is generally attributed to the weight of the implant, compromised breast tissue, or poor skin quality. Surgical revision is needed to elevate and reinforce the inframammary fold. As in the case of implant wrinkling, acellular dermal matrix can be added to bolster breast tissue and prevent tissue thinning (and reduce the risk for implant extrusion).32,33
Mondor’s cordsare firm, cord-like bands caused by superficial thrombophlebitis that can involve the lateral thoracic vein, thoracoepigastric vein, or superior epigastric vein.36,37 This condition presents with abrupt-onset pain in the breast or chest wall, preceded by the appearance of a firm, tender cord. Mondor’s cords usually resolve spontaneously but may be treated with warm compresses, NSAIDs, and use of a supportive bra.37