Treatment For Tuberous Breasts
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Breast Augmentation, more commonly referred to as a breast implant or breast lift, involves utilizing synthetic breast implants or a fat tissue transfer to enlarge the breasts and/or create a more round aesthetic look. Breast Augmentation is also performed in order to restore breast volume that has been lost or deformed due to weight loss, sickness, or pregnancy.
Understanding Tuberous Breasts
Tuberous breasts describe a malformation in the natural development of the breasts in women, mainly in the lower quadrants, associated with a secondary areolar hernia, wide and protruding areola (in 50% of cases) and the ascent of the submammary groove. In general, patients with this pathology have hypotrophic (deteriorating) and asymmetrical breasts.
Tuberous breasts occur during puberty development and can affect one or both breasts. Tuberous breasts are also referred to as constricted breasts or tubular breasts and can manifest the following symptoms: enlarged areola, extra spacing between the breasts, insignificant breast volume, drooping, greater than average breast folds, and a thin breast base.
The deformity is essentially caused by an incomplete embryological mammary development as well as by the formation of a constrictive ring around the areola. All this leads to the herniation of glandular tissue in the subareolar space, which in turn increases the size of the areola due to distension. 3 degrees of severity of this malformation exist: grade I: affects the lower-inner quadrant, grade II: affects the two lower quadrants and grade III: affects the entire breast.
Surgical treatment of tuberous breast is one of the great challenges in breast surgery, since breast augmentation, breast reduction, mastopexy, and mastectomy reconstruction techniques must be put into play simultaneously in order to create a natural looking breast. The most important thing at the time of surgery is to understand the pathogenesis of this malformation (the lack of tissue in the lower breast pole).
Asymmetry is also common in this pathology. Sometimes hypertrophy and glandular ptosis coexist, and this must be corrected simultaneously using implants of different volumes or via reduction surgery and mastopexy in one breast and implant placement in the other. This condition is usually diagnosed during puberty, when breast development begins, and should be resolved as soon as possible to avoid physical and psychological consequences in patients.
Examples of Tuberous Breasts
Surgical Treatment of Tuberous Breasts
A periareolar approach is recommended, since this access can be used to reposition the glandular tissue, correct the submammary groove and place the anatomical implant in a way that leaves the breasts looking natural and symmetrical. This technique avoids the need to make a glandular flap, which reduces surgical time and morbidity by preserving the vitality of tissue. It also decreases the risk of sensitive alterations and provides a very satisfying final look in most patients.
Given the constricted characteristics of this type of breast, the best area to place an implant is in front of the pectoral muscle, to fully expand the breast without the intrusion of tissue. However, in cases with healthy glandular coverage of the implant in the upper pole, the area behind the pectoral muscle is also a good option since it allows the expansion of the lower pole without any muscular intervention.
We must bear in mind that when using breast implants, the pocket where the implant is placed must fit and match the size of the implant. The creation of the pocket must also be atraumatic and bloodless to avoid accumulations and thus reduce the risk of implant rotation. Once the implant is placed, the surgeon may raise the patient into a sitting a position. In this position, the surgeon can evaluate the symmetry, height of the submammary grooves, the final size of both breasts and the position and size of the areolar.
The severity of the tuberosity will determine the degree of enhancement that can be achieved. In very severe cases it may even be necessary to perform the surgery in two stages. First, a breast expander (similar to reconstruction after cancer) is placed to dilate all tissues. In a second procedure, the breast expander is replaced by a definitive implant and the gland and areola are repositioned.
The treatment of the tuberous breast using breast implants implies the need to create a new submammary groove that delimits the lower end of the breast as well as modifying the gland itself to facilitate the adaptation of the tissue. However, in some cases, a double breast groove may appear. In these cases, the primitive submammary groove does not disappear completely after the surgery due to the intense constriction existing in the tissues (skin and gland) remaining, with greater or lesser intensity, above the new groove.
The treatment of double groove is surgical, although, at present, fat grafting is also used as a complementary method since it is very useful to increase tissue volume in specific areas of the breast. It is important to bear in mind that with the passage of time there may again be herniation of the gland through the areola or the double furrow may reappear when the degree of flaccidity increases or there are changes in the patient’s weight.
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