Surgical Treatment of Tubular Breast Type II

Abstract

Background:Tubular breasts are caused by connective tissue malformation and occur in puberty. The main clinical characteristics of the tubular breast are breast asymmetry, dense fibrous ring around the areola, hernia bulging of the areola, megaareola, and hypoplasia of quadrants of the breast. Pathology causes great psychological discomfort to patients.Methods:This study included 17 patients, aged 18 to 34 years, with tubular breast type II who had bilateral pathology and were treated from 2013 to 2016. They had surgical treatment by method of the clinic. Correction technique consisted of mobilization of the central part of the gland and formation of a glandular flap with vertical and horizontal scorings, which looks like a “chessboard,” that was sufficient to cover the lower pole of the implant. The flap was fixed to the submammary folds with stitches that prevented its reduction and accented a new submammary fold. To underscore the importance of the method and to study the structural features of the vascular bed of tubular breast tissue, a morphological study was conducted.Results:Mean follow-up time was 25 months (range between 13 and 37 mo). The proposed technique achieved good results. Complications (hematoma, circumareolar scarring, and “double-bubble” deformity) were identified in 4 patients.Conclusions:Our morphological study confirmed that tubular breast tissue has increased vascularity due to the vessels with characteristic minor malformation and due to the high restorative potential of the vascular bed. Therefore, an extended glandular flap could be freely mobilized without damaging its blood supply; thus, the flap in most cases covered the implant completely and good aesthetic results were achieved.

The Surgical Treatment of Tuberous Breast Deformity

“…Hematoma was identified in 1 patient (6%), 1 patient (6%) had circumareolar scarring, and 2 patients (12%) had a mild double-bubble deformity, no capsular contracture, implant displacement, or palpation, which were noted in any patient. 9 Serra-Renom et al 20 used the modified Puckett's technique on 28 patients with a type III tuberous breast deformity according to Grolleau's classification. A questionnaire was used to evaluate the patients' satisfaction and outcome (very satisfied, satisfied, or not satisfied) after 6 and 12 months, while plastic surgeons evaluated the outcome as excellent, good, or inadequate, and the breast symmetry as having a good symmetry, slight asymmetry, or very asymmetric.…”

“…In addition, the transferred fat integrated well with the native breast fat. 22 Galych et al, 9 who used their own surgical technique for correcting type II tuberous breasts according to Grolleau's classification, evaluated the outcome using the Breast-Q satisfaction scale for 17 patients, and plastic surgeons evaluated the outcome aesthetically as good, fair, or poor based on the breast symmetry, the shape of the lower breast pole, skin irregularities, the diameter of the new areola, and the quality of the circumareolar scars. Patient ratings were more than 82 for their satisfaction with outcome, breast, psychosocial well-being, and sexual well-being using the Breast-Q scale, and all breasts achieved a good outcome aesthetically.…”

“…A modification of von Heimburg et al's 8 scheme was done by Grolleau et al 5 in 1999 who found that types II and III showed no significant objective difference and thus created a 3-type classification scheme based on the level of constriction in the breast base. Grolleau's classification is the most commonly used one 9 by which he regarded type I as having hypoplasia in the lower medial quadrant, type II as having hypoplasia in both lower quadrants, and type III as having hypoplasia in all 4 quadrants 4 …”

“…The breast tissue is lifted to the exterior through the periareolar incision, and the inner surface of the gland is marked horizontally and vertically using electrocautery. This leads to the extension of the breast tissue, or the flap and it should look like a “chessboard.” Implants used are anatomical highly cohesive gel implants 9 …”

Tuberous Breast Management: A Review of Literature and Novel Technique Refinements

“…Other authors have described techniques, with their strengths and weaknesses, where they avoid a periareolar approach. [28][29][30] In this study, we present our one-stage approach with a minimal hemiperiareolar incision, to minimize the time interval for achieving the final result, with reduced scar dimensions, avoiding all the possible complications related to the round block suture. We preferred not to use transcutaneous stitches to replace the flaps in the inframammary fold, but we used internal subcutaneous stitches to anchor the glandular flap, avoiding the possible infection facts that could occur during the removal of stitches or maceration phenomena in the inframammary fold.…”