What is the best surgical technique for operating on a tuberous breast?

Best Surgical Technique for Tuberous Breast Correction

The most effective surgical technique for tuberous breast correction involves a periareolar approach with glandular scoring, release of the constricting ring, and subpectoral implant placement, combined with appropriate mastopexy techniques tailored to the specific deformity type. 1

Understanding Tuberous Breast Deformity

Tuberous breast deformity is characterized by:

• Constricting ring at the base of the breast
• Breast tissue herniation toward the nipple-areola complex
• Hypoplasia and skin deficiency
• Areolar herniation
• Possible asymmetry

Classification-Based Approach

The severity of tuberous breast deformity can be classified into three types, which guides the surgical approach:

1. Type I: Mild deformity with minimal constriction
2. Type II: Moderate deformity with significant constriction
3. Type III: Severe deformity with major constriction and significant breast tissue herniation

Recommended Surgical Technique

Core Components (For All Types)

• Periareolar incision: Provides optimal access while minimizing visible scarring 1
• Glandular scoring: Essential to release the constricting ring that prevents normal breast expansion 2
• Subpectoral (dual-plane) implant placement: Provides better coverage and more natural results 1

Type-Specific Modifications

1. For Type I (Mild) Deformities:

   • Periareolar incision only
   • Minimal glandular scoring
   • Single-stage correction with appropriately sized implant

2. For Type II (Moderate) Deformities:

   • Circumareolar mastopexy
   • More extensive glandular scoring
   • Single-stage correction with implant

3. For Type III (Severe) Deformities:

   • Circumareolar mastopexy with possible vertical component
   • Extensive glandular scoring
   • Consider two-stage correction with tissue expansion before final implant placement

Alternative Techniques

Fat Grafting Approach

• Can be used as a standalone technique for mild to moderate cases
• Provides natural results without implants
• May require multiple sessions (45% need one session, 55% need two sessions) 3
• High patient satisfaction rate (94% very satisfied)
• Avoids implant-related complications

Endoscopically Assisted Technique

• Transaxillary subfascial endoscopic approach
• Minimizes visible scarring by concealing the incision in the axillary fold
• Particularly effective for Type I and II deformities
• Can be combined with fat grafting to correct the "double bubble" appearance 4

Important Considerations

• Nipple-areola complex: Often requires reduction due to herniation of breast tissue 2
• Preservation of lactiferous ducts: Important for maintaining breast function 2
• Avoiding the "double bubble" appearance: Proper release of the constricting ring is essential 4
• Meticulous hemostasis: Critical to prevent hematoma formation which can compromise results 5

Potential Complications

• Capsular contracture (3.9%)
• Implant malposition (3.9%)
• Hematoma
• Asymmetry
• "Double bubble" deformity requiring secondary fat grafting

Follow-Up Care

• Regular post-operative assessments
• Possible secondary procedures for minor adjustments
• Long-term monitoring for implant-related issues if implants are used

By following this classification-based approach and selecting the appropriate surgical technique, consistently good aesthetic outcomes can be achieved in the correction of tuberous breast deformity, with high patient satisfaction rates and minimal complications.