WHAT ARE TUBEROUS BREASTS?
Tuberous breasts are a congenital malformation that can appear in both males and females, and appear with pubertal development. The breasts fail to develop fully. The lower pole is the most affected by this alteration of breast development.
The incidence of this pathology in breast augmentation patients is around 5%, although in the general population it is much higher. Mild cases often go unnoticed by some patients.
TYPES OF TUBEROUS BREASTS
According to the Rees and Aston classification:
-Grade I -affects the inner inner inner quadrant of the breast
-Grade II – affects the two lower quadrants
-Grade III – affects the entire breast
Depending on the severity of the deformity, the breasts may present small features of tuberosity, which sometimes go unnoticed until they are assessed by a specialist, or large deformities that cause patients a great deal of embarrassment and constitute a real aesthetic problem.
Features related to this pathology are: hypertrophic and sometimes herniated areolas, very dilated, large spaces between both breasts, scarce mammary glandular tissue, ascended submammary folds and narrow mammary base. It is also common to see in this type of patients great asymmetries, even presenting in one breast a pronounced hypertrophy and tuberosity, and in the other practically an aplasia (or total absence of breast).
PSYCHOLOGICAL AND FUNCTIONAL IMPACT
The psychological impact of breast deformity that appears at puberty can lead to significant psychosexual problems, so that surgical treatment has been postulated as effective and beneficial to improve self-esteem and facilitate social integration and the development of life activities in a normal way.
On the other hand, it has been described that in cases in which the tuberous breast is related to a shortage of glandular tissue, it can cause low milk supply during lactation.
SURGICAL TREATMENT – TECHNIQUES
The procedure applied will vary greatly depending on the characteristics of each case.
1. Breast Lipofilling. In mild to moderate cases, where the shape of the breast, areola and anatomical arrangement are broadly correct, and the breast presents a volume defect at the expense of gland or adipose tissue.
2. Breast reconstruction with prosthesis. In most cases that come to our office, this is the treatment of choice, with it we get an adequate breast volume. However, it is necessary to add ancillary procedures to achieve a good result: repositioning the submammary fold (usually ascended), reducing the areolar diameter and maintaining an adequate areola shape, releasing the gland well so that it can expand and accommodate the prosthesis (by Puckett flaps or release with transverse Palacin incisions). These procedures eliminate the constriction characteristic of tuberous breasts.
3. Breast Pectomy: sometimes the deformity is in a breast that is totally fallen “ptosis”, and we will need to reconstruct that breast raising it to a more appropriate position. Pexias can be performed without prosthesis, if there is enough tissue, but due to the genesis of tuberous breasts this is usually not the case and it is necessary to complement with a pexy.
4. Correction of asymmetries: in extreme cases of breast aplasia, we have to create an adequate pocket to place a prosthesis, and in the other tuberous breast apply the techniques we have discussed so far.
5. Combination of the above techniques.
6. Tuberous breasts in children: will be treated as a gynecomastia, with removal of the gland and excess fatty tissue, and reconstruction of the areola. If there is a lot of excess skin, it could be removed as well.
RESULTS
Surgery is the only method that manages to give a normal appearance to this type of breasts, which has a very beneficial result at a psychological and self-esteem level, both in men and women.
COMPLICATIONS
Those typical of surgery: hematoma, scarring alterations, infection. These complications have a low incidence, although if they occur and are treated early, the evolution will remain favorable.
Other complications are those related to the use of prostheses, in cases where they have been implanted: seroma, capsular contracture, infection, prosthesis rupture, etc.
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