Tuberous breasts
Cosmetic surgery of the breast increasingly occupies a more
prominent place due to work and / or social reasons, and although its objective
is to achieve an improvement in breast aesthetics, on other occasions it is
aimed at improving the form of certain congenital malformations as occurs in
tuberous and asymmetric breasts.
The tuberous breast, which in many cases its carrier does
not know the diagnosis, affects uni or bilaterally causing important
psychological disorders in those women who carry this breast malformation that
is characterized by a lack of growth of the breast in its entire base or
contour, or in part of it, sometimes adopting a form that resembles that of a
root tuber that some plants have. This anomaly is also known as tubular
breasts, goat breasts, constricted breasts, or “Snoopy” deformity, and its
incidence of occurrence is 30 to 40% of patients who request a mammoplasty in
our office, Logically, the incidence among the general population is much
lower.
Although the specific cause that causes this deformity is
not known, the constrictive band or ring of the base of the breast, prevents
its development in the base, therefore the gland is herniated or ejected
outward, thus generating a tubular base shape narrow and long as a
"tube", which pushes the areola outside.
Solution:
There are many surgical maneuvers to be performed to obtain
a good result and the undervaluation of any of the following will lead to the
result not being satisfactory, a very common thing in inexperienced hands.
First we must reduce the areolar diameter avoiding postoperative dilation, so a
suture should be made around the areola with a non-absorbable suture. This is why
the approach of a tuberous breast in case of augmentation mammoplasty will be
periareolar, then we perform a glandular flap to remove the retractable flange
and get filling of the lower poles. This is the most complicated aspect of
surgery because of the risk, from mistreatment or improper handling of tissues,
from necrosis of the skin of lower poles or the flap performed. Finally, we
include a cohesive gel breast prosthesis of the appropriate size for each case,
favoring the expansion of the lower poles.
Postoperative care:
Since the implants must be placed under the pectoralis major
muscles, we must use in addition to the special bra for these cases for a
minimum period of one month, a Velcro stabilizer band, to block the pocket made
behind the muscle, preventing The implant could be displaced upwards by the
force of the contraction of the muscle itself. The patient cannot lift her arms
or move her elbows away from the chest for a period of one month, nor can she
make great efforts or drive her car for the same period. You should also sleep
on your back and you will need permanent help or help to carry out all your
cleaning and feeding activities for at least the two weeks following the
procedure.
The complications:
The surgical treatment of the tuberous breast requires a very
thorough knowledge of the deformity, hence the endless published techniques.
The simple placement of a prosthesis or implant would cloud
the result since the constriction ring of the base of the breast would generate
the so-called “double groove or double bubble sign”, which we commonly see in
patients undergoing simple breast augmentation surgery , fruit of the
non-diagnosis of the deformity by the inexperienced surgeon
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