Abstract

Tuberous breast, a real challenge: a new classification system and personal approach

Alessandro Innocenti, Marco Innocenti
Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy

Background

Tuberous breast is a rare congenital deformity which may appear in different clinical forms representing various degrees of a single pathological entity. The worst cases are characterised by severe hypoplasia. Following a detailed analysis of the available relevant literature and a significant number of treated cases, in this presentation the authors propose a new classification, with the aim of summarising and simplifying a more intuitive categorisation of the malformation, considering all the clinical aspects and including all types of tuberous breasts, even the minor ones, thus allowing a more immediate diagnosis and surgical planning.

Methods

Between September 2006 and December 2015, 78 patients with tuberous breasts underwent surgical procedures to correct the deformity. Patients' mean age was 18.6 years, ranging between 17 and 26 years. There were 11 monolateral deformities, therefore the treated tuberous breasts amounted to 145. A periareolar approach, adipo-glandular flaps and dual-plane breast implant placements were performed. Post operative follow up include photos collected 12 months after operation. The authors present a personal classification including all the forms of the deformity, plus the minor forms based on the two principal categories: hypoplastic and normoplastic tuberous breasts, taking into account all the clinical aspects of the malformation including the morphology and the consistency of the breast.

Results

Our long-term result is 6 years with a minimum follow-up of 6 months. No particular differences have been noticed between anatomical and round implants in the long run. Anatomical implants become more natural faster, otherwise implant rotations should be considered. No serious complications have been reported. Few cases of NAC temporary hypoestesia resolved spontaneously. No hematoma requiring surgical revision, no NAC necrosis and no necrosis of the adipoglandular flaps; their vitality was not distributed by rotational movement and the pedicles have been demonstrated valid and reliable. Aesthetically pleasing results were ranked as high as 98% by the use of a multiple-choice survey.

Conclusion

Preoperative identification of the type of the deformity is essential to obtain satisfactory results and a complete and intuitive classification, including all the possible variants of the deformity, even the minor forms, and fundamental in diagnosing and resolving the problem. In this paper the authors propose a personal classification and surgical procedure to resolve the malformation.