DOCSLIB.ORG

A Guide to Surgery of the Tuberous Breast

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Guide to Surgery of the Tuberous Breast A Guide to Surgery of the Tuberous Breast Inside this guide: Dear Patient, Welcome 1 Anatomy of the breast 1 Thank you for choosing to explore tuberous breast surgery Tuberous anatomy 2 with Dr. Naidu. This guide was written to help you under- stand the anatomy of the tuberous breast, and your options Options for correction 2 for reconstruction. Please read the following information in its entirety prior to your visit, as this will make your time Silicone versus saline 2 with us more productive. If you have any questions about Implant location 3 anything contained in this material, please print out the relevant sections and we will be happy to discuss them Implant size 3 with you at the time of your consultation. If anyone else will be involved in your decision-making, we ask that you Implant shape/texture 3 bring him or her with you to your visit. We look forward to meeting you. Incision locations 4 Breast lift surgery 4 Risks of surgery 4 Additional factors 5 Surgery and anesthesia 5 Recovery 5 Anatomy of the Breast All breasts are made of fatty tissue, glands, ducts, and skin. Deep to the breast is the chest muscle (pectoralis major). During normal development of the breast, the tissue grows symmetrically across the chest, producing a round shape. Even in the setting of normal development, no woman has two breasts that match exactly, and no surgeon can guarantee perfectly symmetric breasts. It is important that you understand the limitations that may exist due to characteristics of your own breast tissue. Page 2 A Patient’s Guide to Surgery of the Tuberous Breast NINA S. NAIDU, MD, FACS Anatomy of the tuberous breast During development of the tuberous almost always have significant asymmetry. breast, the growth of the tissue may be If an implant is simply placed without re- constricted. While the volume of breast leasing the breast tissue, the result will be a tissue may be normal, it tends to be con- breast mound which falls over the implant. centrated directly below the nipple. As a (Image: Rees TD, Aston SJ: The tuberous result, the breast may appear long and breast. Clin Plast Surg 1976; 3(2): 339-347.) narrow, with herniation of the tissue through the nipple-areolar complex. The nipple-areolar complex tends to be enlarged, and the base of the breast may be relatively narrow. While the extent of de- formity varies from one patient to the next, each of these elements must be ad- dressed to adequately correct the tubular deformity. Patients with tuberous breasts Options for correction of the tuberous breast Correction of the tuberous mammary fold under the and body is determined by breast requires reducing the breast may also need to be both a physical examination size of the nipple-areolar com- lowered. In severe cases, tissue and a frank discussion of your plex, releasing the constricted expansion of the skin and ex- goals. tissue at the base of the breast, isting breast tissue may be rec- and resolving the herniation of ommended prior to insertion tissue through the nipple- of the final implant. areolar complex. In most In some patients with adequate cases, an implant is very help- breast volume, a breast lift ful in providing not only vol- alone can be performed with- ume but also shape to the re- out use of an implant. The constructed breast. The infra- best option for your tissues Breast implants: silicone versus saline Both saline and silicone are SILICONE SALINE FDA-approved for use in -contains a safe, cohesive sili- -contains a salt-water solution breast augmentation. You will cone gel which feels more like which feels firmer than silicone have the opportunity to hold natural breast tissue and feel both implants during -higher risk of visible wrinkling your consultation. Each type -more expensive than saline and rippling implants of implant has its unique bene- -lower price than silicone im- fits and trade-offs. plants A Patient’s Guide to Surgery of the Tuberous Breast NINA S. NAIDU, MD, FACS Page 3 Breast implants: location Breast implants can be placed muscle. Clinical studies have either partially under the pec- repeatedly shown a decreased toralis muscle (submuscular) or incidence of capsular contrac- over the muscle and under the ture (tight scar tissue surround- breast tissue (subglandular). ing an implant) following im- The goal is to provide optimal plantation below the pectoralis long-term coverage of your muscle as opposed to above. implants and to avoid creating deformities which cannot be corrected, including visible implant edges and rippling. For correction of the tuberous breast, Dr. Naidu generally prefers placement under the Breast implants: size The best size implant for a large implants are discouraged, given patient is determined by as an implant which is too large the patient’s measurements. for your tissues can result in These include the base width excessive skin stretch, which of your breast, the amount of may in turn necessitate further stretch of your breast skin, and surgery. The edges of very the amount of breast tissue you large implants may also be already have. The majority of visible under the skin. Because tuberous patients opt for a bra cup size are not standard- modest implant which will ized, Dr. Naidu cannot guaran- correct their deformity. Very tee a specific cup size. Breast implants: shape and texture Both saline and silicone im- surface of the implant can be cially important for teardrop plants are made in round and smooth or textured. Smooth implants. The downside of teardrop shapes. Although implants move easily and feel textured implants is a higher silicone teardrop implants are soft, while textured implants risk of visible wrinkling. an excellent choice for correc- have a slightly bumpy feel on Dr. Naidu most frequently uses tion of the tuberous breast, the surface. The benefit of round, textured implants for they are currently under review texture is that the implant will her tuberous breast patients. by the FDA and are not yet not move as much within the available for general use. The breast pocket, which is espe- Page 4 A Patient’s Guide to Surgery of the Tuberous Breast NINA S. NAIDU, MD, FACS Breast implants: incision locations Although there are three com- mammary fold can also be monly used incision locations lowered through this incision. for placement of breast im- The breast implant is then plants (infra-mammary, peri- placed below the muscle areolar, and trans-axillary), Dr. prior to closing the incision Naidu most frequently selects around the reduce areola. the peri-areolar incision for correction of the tuberous breast. This approach allows the surgeon to reduce the size of the nipple-areolar complex, reduce the herniated breast tissue, and release the con- stricted breast base through one incision. The infra- Breast lift surgery Breast lift surgery involves the inverted T or anchor inci- sions are made, the breast tis- reshaping the breast tissue and sion, in which incisions are sue is lifted and reshaped, the removing excess skin. Incision made around the areola, verti- nipple and areola are reduced options include the cir- cally down to the breast crease, and repositioned, and excess cumareolar pattern in which an and along the inferior breast skin is removed. Sutures are incision is made around the fold. placed deep within the breast areola; the vertical incision, in tissue to support the newly Most tuberous patients who do which incisions are made shaped breasts. The incisions not require a significant release around the areola and vertically are then closed with dissolv- or implants are candidates for down to the breast crease; and able sutures. the vertical lift. After the inci- Risks of surgery All surgery carries specific risks 4) scarring 9) inability to breastfeed and benefits. These risks in- 5) capsular contracture of the 10) unsatisfactory result clude but are not limited to the implant following: 6) pain 1) bleeding 7) change in nipple or breast 2) infection sensation 3) implant rupture 8) reoperation A Patient’s Guide to Surgery of the Tuberous Breast NINA S. NAIDU, MD, FACS Page 5 Other factors beyond our control There are some factors that no There is no guarantee that ad- one can control. Dr. Naidu ditional surgery will success- cannot predict the risk of cap- fully correct the deformity. sular contracture in a given These factors should be patient, and there are no im- weighed and considered care- plants or surgical techniques fully by the patient prior to that can assure that you will undergoing surgery. not develop a contracture. Dr. Naidu also cannot predict or control the amount that your tissues may stretch following surgery. The tendency of a patient to scar well or poorly also cannot be predicted. Surgery and Anesthesia Surgery is performed on an required to obtain medical care for you safely. You will outpatient basis, either in the photographs, routine blood- need to have a responsible hospital or in an ambulatory work, and in some cases pre- adult available to escort you surgery center. The surgery operative clearance from your home after surgery. lasts 2-3 hours, and is per- primary medical doctor. The formed under general anesthe- evening prior to surgery, you sia. Many patients worry about should not eat or drink any- the risk of general anesthesia, thing after midnight. This but it is very safe and it assures ensures that you will have an that you will be completely empty stomach prior to sur- comfortable during surgery. gery, which is very important Prior to surgery you will be for your anesthesiologist to Recovery Following surgery, you will You may return to most nor- are not used.
Load more

Recommended publications
  • Breast-Reconstruction-For-Deformities
    ASPS Recommended Insurance Coverage Criteria for Third-Party Payers Breast Reconstruction for Deformities Unrelated to AMERICAN SOCIETY OF PLASTIC SURGEONS Cancer Treatment BACKGROUND Burn of breast: For women, the function of the breast, aside from the brief periods when it ■ Late effect of burns of other specified sites 906.8 serves for lactation, is an organ of female sexual identity. The female ■ Acquired absence of breast V45.71 breast is a major component of a woman’s self image and is important to her psychological sense of femininity and sexuality. Both men and women TREATMENT with abnormal breast structure(s) often suffer from a severe negative A variety of reconstruction techniques are available to accommodate a impact on their self esteem, which may adversely affect his or her well- wide range of breast defects. The technique(s) selected are dependent on being. the nature of the defect, the patient’s individual circumstances and the surgeon’s judgment. When developing the surgical plan, the surgeon must Breast deformities unrelated to cancer treatment occur in both men and correct underlying deficiencies as well as take into consideration the goal women and may present either bilaterally or unilaterally. These of achieving bilateral symmetry. Depending on the individual patient deformities result from congenital anomalies, trauma, disease, or mal- circumstances, surgery on the contralateral breast may be necessary to development. Because breast deformities often result in abnormally achieve symmetry. Surgical procedures on the opposite breast may asymmetrical breasts, surgery of the contralateral breast, as well as the include reduction mammaplasty and mastopexy with or without affected breast, may be required to achieve symmetry.
    [Show full text]
  • Breast Augmentation Using Preexpansion and Autologous Fat Transplantation: a Clinical Radiographic Study
    COSMETIC Breast Augmentation Using Preexpansion and Autologous Fat Transplantation: A Clinical Radiographic Study Daniel A. Del Vecchio, Background: Despite the increased popularity of fat grafting of the breasts, M.D., M.B.A. there remain unanswered questions. There is currently no standard for tech- Louis P. Bucky, M.D. nique or data regarding long-term volume maintenance with this procedure. Boston, Mass.; and Philadelphia, Pa. Because of the sensitive nature of breast tissue, there is a need for radiographic evaluation, focusing on volume maintenance and on tissue viability. This study was designed to quantify the long-term volume maintenance of mature adi- pocyte fat grafting for breast augmentation using recipient-site preexpansion. Methods: This is a prospective examination of 25 patients in 46 breasts treated with fat grafting for breast augmentation from 2007 to 2009. Indications in- cluded micromastia, postexplantation deformity, tuberous breast deformity, and Poland syndrome. Preexpansion using the BRAVA device was used in all patients. Fat was processed using low–g-force centrifugation. Patients had pre- operative and 6-month postoperative three-dimensional volumetric imaging and/or magnetic resonance imaging to quantify breast volume. Results: All women had a significant increase in breast volume (range, 60 to 200 percent) at 6 months, as determined by magnetic resonance imaging (n ϭ 12), and all had breasts that were soft and natural in appearance and feel. Magnetic resonance imaging examinations postoperatively revealed no new oil cysts or breast masses. Conclusions: Preexpansion of the breast allows for megavolume (Ͼ300 cc) grafting with reproducible, long-lasting results that can be achieved in less than 2 hours.
    [Show full text]
  • 38 Aesthetic Reconstruction of the Tuberous Breast Deformity
    Chapter 38 Aesthetic Reconstruction 38 of the Tuberous Breast Deformity Apostolos D. Mandrekas, George J. Zambacos 38.1 to assume a more natural shape. Vecchione, also in 1976 Introduction [22], described the donut-type periareolar excision for correcting the “domed nipple.” Williams and Hoffman The tuberous breast deformity is a rare entity affecting [23] described a technique with periareolar excision, teenage women unilaterally or bilaterally [1, 2]. Its ex- radial incisions on the posterior aspect of the breast pa- act incidence has not been properly investigated and renchyma, and implant placement. Toranto [1] used a remains unknown [1, 2]. Nonetheless, this deformity two-stage technique, with implant augmentation in the produces much psychological morbidity and presents a first stage and an Arie–Pitanguy type of skin–areola re- reconstructive challenge for the plastic surgeon. duction at a second stage. The tuberous breast deformity was first described in Ribeiro at al. [15] recognized the need to release the 1976 by Rees and Aston [3] and was thus named be- constricted breast, but they concentrated on a horizon- cause “it resembled the shape of a tuberous plant root.” tal division of the inferior part of the breast, develop- Unfortunately, in that same, seminal paper the authors ing an inferiorly based flap.Puckett developed a similar described another “similar,” as they said, deformity, the “unfurling” technique (C. Gasperoni, personal commu- “tubular breast,” and since then several papers have been nication, 1998). Dinner and Dowden [12] and Elliott published on the subject, each using its own nomen- [16] believed the deformity was due to skin shortage in clature and producing much confusion among plastic the inferior part of the breast and followed a different surgeons [4].
    [Show full text]
  • Read Article
    COSMETIC Tuberous Breast Deformity: Classification and Treatment Strategy for Improving Consistency in Aesthetic Correction Adam R. Kolker, M.D. Background: Tuberous breast deformity is a common congenital anomaly with Meredith S. Collins, M.D. varying degrees of constriction, hypoplasia, skin deficiency, areolar herniation, New York, N.Y. and asymmetry that poses challenges to consistency in aesthetic correction. In this study, the authors classify tuberous breast deformities, and evaluate their techniques used for treatment. Methods: Twenty­six patients (51 breasts) treated from 2008 to 2012 were in­ cluded. Mean patient age was 25 years (range, 18 to 39 years). Cases were clas­ sified using a three­tier system. A periareolar approach and glandular scoring maneuvers were used in all cases. Prosthetic placement (implant or tissue ex­ pander) was subpectoral (dual­plane) in all cases. The selection of one­ versus two­stage correction and mastopexy techniques is presented with reference to the specific deformities in each tier. Results: Mean follow­up was 22 months (range, 8 to 37 months). Twelve type I, 26 type II, and 13 type III deformities were treated. Periareolar incisions only were used in two (4 percent). Circumareolar mastopexy was used in 49 (96 percent), and vertical mastopexy was used in four (8 percent). One­stage cor­ rection was achieved in 47 (92 percent); four (8 percent) were treated in two stages with tissue expansion. The global complication rate for all patients in this study is 7.8 percent—two breasts (3.9 percent) had capsular contracture, and two (3.9 percent) had postoperative malposition. SUPPLEMENTAL DIGITAL CONTENT IS AVAIL- Conclusion: The authors’ experience demonstrates that satisfactory results ABLE IN THE TEXT.
    [Show full text]
  • Breast Augmentation: Surgical Decisions & Complications
    Breast Augmentation: Surgical Decisions & Complications Karol A Gutowski, MD, FACS Instructional Course Disclosures Angiotech/Surgical Specialties - Advisory Board AxcelRx Pharmacuticals - Advisory Board Suneva Medical - Instructor Will use brand names for ease of understanding Objectives • Incision selection • Pocket selection • Implant selection – Saline vs gel – Smooth vs textured • Preventing complications – Malposition, capsular contracture • Anesthesia & analgesia Too Many Implant Options? Implant Size Selection • Do NOT promise a cup size – Victoria’s Secret has larger cups sizes • Use a measurement system – Sternal Notch to Nipple – Upper Pole Pinch – Base Width – Areolar Diameter – Nipple to IMF (stretch) – Inter Mammary Distance Size Selection: What Else Helps Saline Implants • Favorable cost • Smaller incision • “Safer” • Adjustable size range • Deflation known (no surveillance) • Rippling, palpability (in thinner breast tissue) • OR time (few minutes) • Not for – Thin patients – Small breast Saline Implants Rippling in thin breast tissue Thick breast tissue Good result Structured Saline Implants • Smaller incision • “Safer” • Adjustable size range • Deflation known (no surveillance) • Less rippling, palpability? (in thinner breast tissue) • Higher cost • OR time (few minutes) Gel Implants • More natural look & feel • Shorter OR time • Shell integrity not known (MRI surveillance) • Longer incision • Gel concerns • Higher cost Implant Profiles Match breast width to implant width Not Commonly Common, Not for commonly used more
    [Show full text]
  • Breast Augmentation Historic Plagues BOARD of DIRECTORS
    NEWS OFFICIAL NEWS OF THE INTERNATIONAL SOCIETY OF AESTHETIC PLASTIC SURGERY 2 14 | Volume Number 2 Number INSIDE New Webinar Series Global Perspectives: Breast Augmentation Historic Plagues BOARD OF DIRECTORS PRESIDENT Dirk Richter, MD, PhD Wesseling, GERMANY [email protected] PRESIDENT-ELECT Nazim Cerkes, MD, PhD Istanbul, TURKEY [email protected] FIRST VICE PRESIDENT Lina Triana, MD Cali, COLOMBIA [email protected] SECOND VICE PRESIDENT Gianluca Campiglio, MD, PhD Milan, ITALY [email protected] THIRD VICE PRESIDENT Arturo Ramirez-Montanana, MD Monterrey, MEXICO NO. [email protected] VOLUME 14 SECRETARY 2 Ivar van Heijningen, MD Knokke-Heist, BELGIUM [email protected] TREASURER Kai-Uwe Schlaudraff, MD, FEBOPRAS Geneva, SWITZERLAND CONTENTS [email protected] HISTORIAN Peter Scott, MD Message from the Editor 3 Johannesburg, SOUTH AFRICA [email protected] Message from the President 4 PARLIAMENTARIAN Tim Papadopoulos, MD Education Council Update 7 Sydney, AUSTRALIA [email protected] Visiting Professor Program 8 EDUCATION COUNCIL CHAIR Managing during COVID-19 10 Vakis Kontoes, MD, PhD Athens, GREECE ISAPS Insurance 17 [email protected] Obituaries 18 EDUCATION COUNCIL VICE CHAIR Ozan Sozer, MD El Paso, Texas, US Journal Update 20 [email protected] Global Sponsor Feature 21 NATIONAL SECRETARIES CHAIR Michel Rouif, MD Global Perspectives 23 Tours, FRANCE [email protected] Case Study 69 PAST PRESIDENT Renato Saltz MD, FACS Surgical Marking 75 Salt Lake City, Utah,
    [Show full text]
  • Breast Concerns and Disorders in Adolescent Females
    Review Article Page 1 of 8 Breast concerns and disorders in adolescent females Donald E. Greydanus1, Lyubov Matytsina-Quinlan2 1Department of Pediatric & Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA; 2East Cheshire Centre for Sexual Health, East Cheshire NHS Trust, Macclesfield District General Hospital, Macclesfield, Cheshire, SK103BL, UK Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final Approval of manuscript: All authors. Correspondence to: Donald E. Greydanus. Department of Pediatric & Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA. Email: [email protected]. Abstract: Breast disorders are an important aspect of health care for adolescent females and this discussion presents principles for education and management of breast concerns as well as problems for this population of patients. Normal and abnormal breast development are considered. Breast pathology that is reviewed include congenital lesions as well as breast asymmetry, atrophy, tuberous breasts, fibroadenoma, cystosarcoma phyllodes, benign breast disease, mastalgia and other breast disorders. Keywords: Athelia; polymastia; fibroadenoma; mastitis; mammary hyperplasia; fibrocystic change Received: 11 June 2019; Accepted: 17 June 2019; published: 03 July 2019. doi: 10.21037/pm.2019.06.07 View this article at: http://dx.doi.org/10.21037/pm.2019.06.07 Introduction a mother or other close relative has a breast cancer history. In the primary care medical practice, the adolescent female Breast disorders are an important aspect of health care may present with a number of concerns related to the size, for female adolescents (1-7).
    [Show full text]
  • Breast Reconstruction for Deformities Unrelated to Cancer Treatment
    ASPS Recommended Insurance Coverage Criteria for Third-Party Payers Breast Reconstruction for Deformities Unrelated to Cancer Treatment BACKGROUND Hypertrophy of breast N62 For women, the function of the breast, aside from the periods Other specified disorders of the breast N64.89 when it serves for lactation, is an organ of female sexual Acquired deformity of chest and rib M95.4 identity. The female breast is a major component of a woman’s Congenital deformity of chest wall Q67.8 self-image and is important to her psychological sense of Poland’s Syndrome Q79.8 femininity and sexuality. Both men and women with abnormal Congenital absence of breast with absent nipple Q83.0 breast structure(s) often suffer from a severe negative impact on Accessory breast Q83.1 their self-esteem, which may adversely affect his or her well- Absent nipple Q83.2 being and result in significant to severe physical disability. Accessory nipple Q83.3 Other congenital malformations of breast Q83.8 Breast deformities unrelated to cancer treatment occur in both men and women and may present either bilaterally or Sequela, Burn of unspecified degree, chest wall T21.01xS unilaterally. These deformities result from congenital anomalies, Sequela, Burn of second degree, chest wall T21.21xS trauma, disease, or mal-development. Because breast Sequela, Burn of third degree, chest wall T21.31xS deformities often result in abnormally asymmetrical breasts, Sequela, Corrosion of unspecified degree, chest wall T21.41xS surgery of the contralateral breast, as well as the affected breast, Sequela, Corrosion of second degree, chest wall T21.61xS may be required to achieve symmetry.
    [Show full text]
  • Factors Associated to Breast Implants and Breastfeeding*
    ORIGINAL ARTICLE DOI: http://dx.doi.org/10.1590/S1980-220X2017037803363 Factors associated to breast implants and breastfeeding* Fatores associados à mamoplastia de aumento e o aleitamento materno Factores asociados a la mamoplastia de aumento y la lactancia materna Karla Oliveira Marcacine1, Erika de Sá Vieira Abuchaim1, Kelly Pereira Coca1, Ana Cristina Freitas de Vilhena Abrão1 How to cite this article: Marcacine KO, Abuchaim ESV, Coca KP, Abrão ACFV. Factors associated to breast implants and breastfeeding. Rev Esc Enferm USP. 2018;52:e03363. DOI: http://dx.doi.org/10.1590/S1980-220X2017037803363 * Extracted from the thesis: “A mamoplastia ABSTRACT de aumento e a prática do aleitamento materno”, Universidade Federal de São Paulo, Objective: To analyze the association between the surgical characteristics of breast Escola Paulista de Enfermagem, 2017. implants, time elapsed since surgery, access route, implant placement and implanted volume 1 and variables related to breastfeeding, type, first ‘milk let-down’, breast engorgement, Universidade Federal de São Paulo, Escola Paulista pain, lesion, milk production and use of galactagogues. Method: A prospective cohort de Enfermagem, Departamento de Enfermagem th th em Saúde da Mulher, São Paulo, Brazil. carried out during the hospital stay (12 to 72 hours after delivery), home care (5 to 7 day after delivery) and telephone contact (between the 30th and 32nd day postpartum) of 115 postpartum women with breast implants between 2015 and 2017. Results: The first evaluation identified more frequent use of oral galactagogues (p=0.029) by puerperal women with prepectoral implants, and of oxytocin spray by those with implants up to 270 ml (p=0.040).
    [Show full text]
  • Treatment of Tuberous Breast with Combined Incisions Tratamento De Mamas Tuberosas Com Incisões Combinadas
    ORIGINAL ARTICLE Treatment of tuberousVendraminFranco breast T FS etwith al.et al.combined incisions Treatment of tuberous breast with combined incisions Tratamento de mamas tuberosas com incisões combinadas MANOEL PEREIRA SILVA NETO1 ABSTRACT LUCIANA RODRIGUES DA Background: Tuberous breast deformity is a rare entity, first described by Rees and Aston CUNHA COLOMBO2 in 1976. In this condition, breast development is altered, with herniation of the parenchyma DIEGO DE PAIVA SILVA2 through the nipple-areolar complex, enlargement of this structure, and hypoplasia of the PAULO MAGNO SANTOS breast tissue, especially in the lower quadrants. The breast thus acquires a tubular shape GUIMARÃES3 rather than the natural conical look. Methods: Four patients underwent a single surgical CYNTHIA OTTAIANO treatment, with combined inframammary and periareolar incisions. Technical details must RODRIGUES ALMEIDA4 be individualized for each case depending on the severity and classification type of the tu- ADRIANO PEDUTI BATISTA4 berous breasts. Results: The surgical procedure used covers all aspects of tuberous breast LUIZ HUMBERTO TOYOSO deformity in a single-stage operation. Revision of periareolar surgery scar was not neces- CHAEM1 sary in any case. In all cases, the final aesthetic result was satisfactory for the patient and MARCO TÚLIO RODRIGUES DA the surgeon. The procedure adopted does not interfere with future lactation. Conclusions: CUNHA1 Tuberous breast represents a real therapeutic challenge. The technique reported herein is very attractive and provides reliable and reproducible results. Keywords: Breast/surgery. Mammaplasty. Plastic surgery/methods. RESUMO Introdução: A deformidade tuberosa da mama é uma rara entidade, descrita por Rees e Aston em 1976. O desenvolvimento mamário encontra-se alterado, com herniação do pa- rênquima pelo complexo areolopapilar, alargamento dessa estrutura e hipoplasia do tecido mamário, principalmente nos quadrantes inferiores.
    [Show full text]
  • Original Article Vertical Approach to the Pectoralis Major in Breast Implant Insertion Abordagem Vertical Do Peitoral Maior Nas Inclusões Mamárias
    Original Article Vertical approach to the pectoralis major in breast implant insertion Abordagem vertical do peitoral maior nas inclusões mamárias ESTÉFANO LUIZ FAVARETTO 1* ■ ABSTRACT Introduction: This study demonstrates an alternative method to access the retromuscular space and avoid undesirable effects caused by breast implant insertion in this space. Methods: We evaluated 328 female patients, aged 17 to 62 years, with complaints of micromastia and bilateral ptosis. All patients underwent insertion of bilateral implants using a vertical incision in the pectoralis major. Follow-up was performed for at least 6 months. Results: The technique of vertical incision in the pectoralis major increases the options for access to the retromuscular space in breast implant insertion. This method successfully achieves appropriate positioning of the implant and avoids additional scars. Conclusions: The technique proved to be effective, avoiding scars and the double-bubble effect, and increases the options for access to the retromuscular space. Keywords: Mammary implants; Prostheses and implants; Mammoplasty; Breast; Reconstructive surgical procedures. ■ RESUMO Introdução: O trabalho demonstra uma abordagem alternativa para ampliarmos a escolha do espaço retromuscular e evitarmos os efeitos indesejáveis nas inclusões de próteses mamárias neste plano. Métodos: Foram avaliados 328 pacientes do sexo feminino, com idade entre 17 e 62 anos, com queixa de hipomastia e certo grau de ptose mamária bilateral. Todas as pacientes foram submetidas à inclusão de próteses bilaterais e incisão vertical no músculo peitoral maior. A avaliação foi realizada com um período mínimo de 6 meses. Resultados: A tática cirúrgica de incisão vertical no músculo peitoral maior nos permitiu ampliar a indicação do espaço retromuscular nas cirurgias de Institution: Clínica de Cirurgia inclusão de próteses de mamas, conseguindo alcançar com êxito Plástica Dr.
    [Show full text]
  • Developmental Breast Asymmetry
    ORIGINAL ARTICLE Developmental Breast Asymmetry WoanYi Chan, MSc, MRCS, MEd, Bhagwat Mathur, MCh (Plast), FACS, Diana Slade-Sharman, BSc (Hons), MSc , and Venkat Ramakrishnan, MS, FRACS St Andrew’s Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, Essex, UK n Abstract: Developmental breast asymmetry (DBA) can affect psychosocial well-being in the young female. Correction of breast asymmetry may present a reconstructive challenge, especially in tuberous breasts. Fifty-two cases of DBA treated between January 2002 and January 2006 were reviewed. Preoperative clinical assessment of the specific anatomical defor- mity, subsequent surgical treatment modalities, esthetic outcome, and patient’s satisfaction were evaluated. Surgical modal- ities used in our series include augmentation mammaplasty with or without tissue expansion, parenchymal scoring, nipple areola complex reduction, glanduloplasty techniques, mastopexy and reduction mammaplasty. The mean age of DBA pre- sentation was 21 years; 69% (36 ⁄ 52) patients had tuberous breasts, of which 67% (24 ⁄ 36) were unilateral and 33% (12 ⁄ 36) were bilateral deformities. Patients with tuberous breast deformity presented consistently under the age of 25 years. Esthetic outcome was rated ‘‘good’’ in 75% (39 ⁄ 52), and symmetry rated as ‘‘good’’ in 58% (30 ⁄ 52) by professional evalua- tion. Surgical treatment is tailored to the affected esthetic units of the individual breast. In our experience, symmetry is the hardest parameter to achieve, particularly in tuberous breasts. Operative treatment is of great value to the psychosocial well-being of the patient. A conceptual approach in the assessment and treatment of DBA is emphasized by this series. n Key Words: breast asymmetry, breast development, congenital breast anomalies, congenital breast deformity, tuberous breast he female breast is an important symbol of femi- asymmetries cases was carried out.
    [Show full text]