Query: tuberous breast

title: Autologous Fat Grafting with Percutaneous Fasciotomy and Reduction of the Nipple Areolar Complex for the Correction of Tuberous Breast Deformity in Teenagers
abstract: Tuberous breast deformity in the adolescent can be a source of anxiety and social isolation. Current techniques of implant placement and flap reconstruction are not always feasible in this population.  The authors evaluated the use of autologous fat grafting with percutaneous fasciotomy and reduction in the nipple areolar complex for correction of tuberous breast deformity in teenagers.  A retrospective chart review was conducted for nine teenaged patients with tuberous breast deformity who received autologous fat grafting between January 2016 and December 2018. The recipient site was prepared with the use of percutaneous fasciotomies to release the constricted lower pole of the breast, lowering of the inframammary crease, and reduction in the nipple areolar complex. Fat was harvested by conventional liposuction prior to injection through three designated sites located at the inframammary fold, anterior axillary line, and upper pole. Complications were recorded.  Patients had an average age of 14.9 years at the time of surgery. An average of 1.8 filling sessions were required with a mean of 220 cc of fat injected per breast. Patients were followed for an average of 21 months postoperatively. No serious complications were noted. All patients reported satisfaction with their final outcomes.  Autologous fat grafting in conjunction with percutaneous fasciotomy and reduction in the nipple areolar complex is a safe and effective treatment of the tuberous breast deformity in teenage patients. It provides an esthetic result with minimal scarring and high satisfaction rates while eliminating the need for flaps or implants.

title: One Stage Correction of Tuberous Breast Deformity Using Saline Implants: Without the Need for Radial Scoring or Lowering the Inframammary Fold
abstract: Tuberous breasts are a congenital anomaly in which the breasts fail to develop normally. This abnormality may include hypoplasia, a tubular appearance, a higher inframammary fold (IMF) and sometimes a herniated nipple areolar complex. Correction of tuberous breast deformity (TBD) is traditionally done with a 1 stage breast augmentation with radial scoring of the constricted breast tissue and/or the lowering of the IMF. An alternative 2 stage approach first uses a tissue expander to correct the deformity; the expander is later replaced with a permanent breast implant. Sixteen patients are presented in which a 1 stage correction of TBD was successfully accomplished with saline implants acting as tissue expanders. In all cases, the expansion remedied the deformity without the need for radial scoring of the breast tissue or lowering of the IMF. This approach has not been reported in the literature. Sixteen women (32 breasts) were treated, with TBD ranging from mild to severe. All patients had a breast augmentation with round, smooth saline implants placed through an IMF incision in the dual plane (partially subpectoral and partially submammary) Implants ranged in size from 225 cc to 675 cc. The IMF was never lowered and the breast parenchyma was never radially scored. Three patients had asymmetry requiring breast implants of different sizes, and one had a circumareolar mastopexy to repair a herniated areolar complex. Representative case examples are provided. The average follow up time was 9 months. All deformities were corrected, and the patients expressed satisfaction with their results. There were no occurrences of hematoma, infection, capsular contracture, or malposition. This review has shown that saline breast implants alone, with their inherent expansion capability, can correct TBD without the increased morbidity associated with radial scoring and lowering the IMF. For patients who choose saline implants, this single stage, less invasive surgical approach can provide a good aesthetic result.

title: Letter to the Editor on: "Tuberous Breast Deformity Correction: 12 Year Experience"
abstract: Dear Editor, We read with interest the article 'Tuberous Breast Deformity  12 year Experience' by V. Zholtikov et al.  which explores a one stage technique of mammary gland parenchyma scoring with a dual plane pocket for treatment of tubular breast deformity. We would like to thank the authors for the interest in our article. Surgeries on tuberous breasts are becoming increasingly frequent, and the development of different approaches is a recurrent theme in plastic surgery. This problem has been of interest in our research over the past years and has been investigated in a retrospective analysis  on 1600 female patients from January 2009 to July 2014. Findings showed increasing incidence of stenotic breast deformity (TBD) in the general population, with specific regards in patients seeking breast augmentation or breast reduction (about 50% The different clinical assessments of TBD allowed us to stipulate a classification  based on stenosis type, parenchymal trophism, and glandular ptosis. Furthermore, the paper proposes different surgical maneuvers used for the treatment of TBD. Zholtikov's approach is similar to the one employed in our experience, specifically in the complete gland detachment and the use of a periareolar approach. This technique allows for mammary ptosis correction, especially in relation to lowering the position of the inframammary fold by detaching the gland from the fascial layer, thus obtaining minimal scarring processes and more aesthetic results. On the basis of Zholtikov's observations on the high concentration of fibrotic components in TBD, we believe that the employment of autologous fat grafting (AFT) could be beneficial in the correction of breast deformities. Our experience with AFT shows successful outcomes in the treatment of fibrotic tissues such as scars, ulcers, and burn injury outcomes. The efficacy of lipofilling is based upon a significant reduction in scar hardness and extension of treated area after treatment. The molecular mechanisms of mesenchymal stem cells and adipocyte derived products contained in the graft allow for tissue remodeling, increased collagen deposition, neoangiogenesis, and dermal hyperplasia  On the basis of these findings, AFT can be applied to the correction of the lower pole of the fibrotic gland, allowing for progression in tissue regeneration processes and M. Klinger Marco.klinger@humanitas.it

title: Correction of the tuberous breast deformity in a prepubescent male patient: A surgical approach to an unusual problem
abstract: The management of the tuberous breast deformity in the female patient is well described. However, the presence of this variant in male patients is particularly rare, and few reports on the management of this condition are available. Case presentation A 12 year old prepubescent male with bilateral gynecomastia and tuberous breast deformities was referred to our department for treatment. Our surgical management, including free nipple areolar complex harvest, mastectomy, removal of excess skin and subsequent nipple grafting, is presented in detail. We observed a cosmetically acceptable result with restoration of a masculine appearing nipple areolar complex and good patient satisfaction at 6 month follow up.  Tuberous breast deformities in male patients are rare. Our treatment of a prepubertal male patient with this deformity using mastectomies and free nipple areolar complex grafting provided a cosmetically acceptable result. Here, we review the current literature on tuberous breast deformities in males and describe our approach to treatment.

title: Male Tuberous Breast: A Rare Variant of Gynecomastia. Clinical Considerations and Personal Experience: Tips and Tricks to Maximize Surgical Outcomes
abstract: Tuberous breast deformity, even rarely, might be observed in the gynecomastia population. It can clinically appear very similar to tuberous breast in females, including a footprint resembling a feminine inframammary fold (IMF) Because of its anatomical characteristics, its correction could benefit from particular surgical measures and therefore it should be careful diagnosed. A clear footprint defining a very feminine inframammary fold is very difficult to correct and renders very difficult the management of the extra skin. Transection of the fibrous constrictions at the level of inframammary fold is not sufficient to obtain a satisfactory result, and adjunctive surgical measurements are required. From January 2007 to December 2015, twenty one patients, affected by gynecomastia with tuberous breast deformity, underwent surgical correction consisting of parenchyma debulking and transection of the stenotic fibrous ring of the footprint. The recontouring of the chest profile was optimized using parenchymal flaps which helped to maximize the surgical correction with minimal scarring. The mean age at surgery was 28.8 years. The average follow up period was 32 months. The average hospitalization stay was 1.28 days. Routine laboratory tests and histological examinations did not demonstrate any anomalies. No major complications and no recurrences of the disorders have not been observed. No major complications were reported: one seroma, one skin depression, two scar revisions and three cases of bilateral minimal crescent ptotic skin appearance were observed. Although tuberous breast in the gynecomastia population is a rare clinical entity, it should be taken into consideration because it could benefit from some specific surgical measures. The use of glandular flaps showed a satisfactory reshaping of the pectoral area. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

title: Response to: "One Stage Correction of Tuberous Breast Deformity Using Saline Implants: Without the Need for Radial Scoring or Lowering the Inframammary Fold"
abstract: Dear Editor, We read with interest the article "One Stage Correction of Tuberous Breast Deformity Using Saline Implants: Without the Need for Radial Scoring or Lowering the Inframammary Fold" by T. Eisenberg. We thank the author for the interest in our article. The author presents the correction of tuberous breast deformity (TBD) through a 1 stage breast augmentation surgery in 16 women. Patients were classified into 4 hypoplastic tuberous breast types and were treated with the same procedure. The author's approach consists in an inframammary fold (IMF) incision followed by a dual plane saline round implant insertion. The importance TBD is assuming over the past years has led to the development of many approaches to its correction, which often diverge depending on surgeon's experiences. Consequently, we have observed differences between Eisenberg's and our procedures for TBD correction. Our studies on TBD date back to 2016, when we performed a retrospective analysis on 1600 female patients. Findings reported an increasing incidence of TBD in the general population and a prevalence of 50% of TBD patients seeking breast augmentation or breast reduction. In 2017, we have investigated TBD based on stenosis type, parenchymal trophism, and glandular ptosis. This study allowed us to allocate tuberous breast into 8 groups and to develop methods depending on the different characteristics of such classification. Similar to Eisenberg's, our experience is based on the use of a 1 stage procedure and double plane technique. We agree with the effectiveness of such techniques in providing a lessinvasive procedure and more aesthetic outcomes. Differences, instead, comprise mainly in the author's choice of using an IMF incision, rather than a periareolar approach as we prefer, and in the longitudinal and transverse scoring of the stenotic gland parenchyma. The use of a periareolar approach, followed by a mastopexy procedure, provides the correct repositioning of the nipple areolar complexes to the area of maximum projection, in case it is displaced to different locations on the breast. Furthermore, if the mammary lower pole is short, this type of access allows for the advantage to lower the IMF. According to the approach of the glandular tissue, we found necessary the complete gland detachment from the fascia layers, to place it symmetrically to the contralateral breast. The high concentration of fibrotic component in tuberous breast is the causative agent for the characteristic increasing hardness and loss of elasticity of the gland. Parenchyma modification by means of transverse and longitudinal scoring was found to decrease these two physical parameters. This technique had, therefore, a great impact in lowering complications of nonelastic tissues, such as the doublebubble defect, which is otherwise difficult to avoid in hypoplastic breasts. In addition to the scoring technique, our experience with autologous fat grafting (AFT) in the treatment of retractile scars reports qualitative improvements in tissue elasticity. The fibrotic characteristics of scars can be associated with the histological features seen in TBD. The regenerative abilities of lipofilling allow for more aesthetic and functional results in stenotic tissues; hence, they are employed as breast contouring technique in TBD treatment.

title: Tuberous Breast Deformity Correction: 12 Years Experience

title: Autologous Fat Grafting with Percutaneous Fasciotomy and Reduction of the Nipple Areolar Complex for the Correction of Tuberous Breast Deformity in Teenagers

title: Tuberous Breast: Past, Present, and Future Personal Classification, Treatment, and Surgical Outcomes
abstract: Tuberous breast (TB) is a rare congenital deformity, which may appear in different clinical forms representing various degrees of a single pathological entity. The worst cases are characterized by severe hypoplasia. Following a detailed analysis of the available relevant literature and a significant number of treated cases, in this article, the authors propose a new classification, with the aim of summarizing and simplifying a more intuitive categorization of the malformation, considering all the clinical aspects and including all types of TBs, even the minor ones, thus allowing a more immediate diagnosis and surgical planning.  Between September 2006 and December 2015, 78 patients with TBs underwent surgical procedures to correct the deformity. The patients' mean age was 18.6 years, ranging between 17 and 26 years. There being 11 monolateral deformities, the treated TBs amounted to 145. A periareolar approach, adipo glandular flaps, and dual plane breast implant placements were performed. Postoperative follow up include photos collected 12 months after operation. The authors present a personal classification including all the forms of the deformity, plus the minor forms based on the following 2 principal categories: hypoplastic and normoplastic TBs, taking into account all the clinical aspects of the malformation including the morphology and the consistency of the breast.  Preoperative identification of the type of the deformity is essential to obtain satisfactory results and a complete and intuitive classification including all the possible variants of the deformity, even the minor forms, and fundamental in diagnosing and resolving the problem. In this article, the authors propose a personal classification and surgical procedure to resolve the malformation.

title: Fat Grafting Technique, A Paradigm Shift in the Treatment of Tuberous Breast
abstract: The tuberous breast syndrome is a condition that affects young women and can bring on serious disorders of self esteem. There are numerous surgical techniques to correct this condition, but most of them include the use of breast implants to replace lack of volume. Nowadays, patients are increasingly becoming more demanding to get a definitive solution with minimal aesthetic sequelae.  We present a series of 11 patients with tuberous breast deformities treated with lipofilling technique. Fat harvest was performed by conventional lipoaspiration with 3 mm cannulas, centrifuged at 2000 rpm for 2 minutes and injected in the breast were was needed with 1.9 mm blunt cannulas.  The patient's average age was 24 year old with a BMI of 23.4 kg/m2. Volumes between 80 and 250 ml per breast were injected in every session, requiring a total volume of 413 ml per breast. Most patients required up to two procedures to achieve the complete breast correction. The mean follow up was 29.7 months. All patients had good aesthetics results with minimal complications.  Natural breast mound with excellent cosmetic result can be achieved with fat grafting. Fat grafting main advantage is to respond to physiological changes in weight over time. In addition, lipofilling do not carry the inherent complications of implants. We strongly believe it is a safe and easy technique to reproduce in properly selected patients and with minimal morbidity it can cause the best natural result.