Correction of Tuberous (Tubular or Constricted) Breast Deformity

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Tuberous breast deformity also known as tubular, snoopy breast, herniated areola complex, constricted breast, narrow based breast, lower pole hypoplasia is a deformity that usually becomes evident at puberty in young women. It is characterized by a wide spectrum of presentation including constriction of the breast base, glandular and skin hypoplasia (especially at the lower quadrants), mal-position of the infra-mammary fold, breast tissue herniation into the areola region and sometimes increased areola diameter. The condition may be unilateral or bilateral and is often asymmetric. It may present as a severe mal-formation and is extremely physically and psychosocially relevant; the patient sometimes avoids medical check ups, give up outdoor sports, wear clothing hiding their shape and avoid sexual intercourse. Treatment can be a surgical challenge. The main goals are to correct the deformity in a one stage operation, restore the mammary base dimensions, correct the hypoplasia of the lower quadrant of the breasts, re-position the infra-mammary fold, reduce the areola dimensions and achieve good symmetry.

The procedure begins with marking of the “new” infra-mammary fold by projection of the unilateral breast in unilateral cases or by using a sixth rib as a landmark in bilateral cases. In severe constriction, the location of the new infra-mammary fold is selected so that approximately 50-60% of the planned breast implant will fit from the nipple to the fold. Again, treatment is based on the anatomic deformity of deficiency in the horizontal and vertical dimensions of the breast characterized by underdevelopment of the breasts with “herniation” of breast tissue into the areola associated with hypertrophy of the areola. Access is through a circumareola approach. This access allows for correction of disproportionate diameter of the areola and closure of the lower pole of the breast. The lower pole of the breast is addressed with radial incisions on the deeper aspect of the breast.

This results in the release of the constricting ring at the breast space. This release allows for the rounding out of the lower pole of the breast which will be maintained with a breast implant. Size adjustment of the breast may include reduction and/or lifting of the larger breast. This glandular resection of the larger breast may allow for placement of implants of same or similar size. These maneuvers are used to achieve as much symmetry as possible.

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