Aberrant mammary tissue and nephrourinary malignancy

Polythelia (supernumerary nipple) provides a clue to congenital and hereditary malformations of the kidney and the urinary collecting system. It is also regarded as a cutaneous paraneoplastic marker because of the significant association with urogenital malignancies. A 38-year-old man with sporadic left supernumerary nipple without evidence of ear, facies, or gonadal defects or lateral displacement of the nipples was routinely examined for the presence of renal anomalies. Investigation revealed left polycystic kidney disease with adenocarcinoma in the upper pole. The nephrocutaneous defects and renal malignancy showed a peculiar ipsilaterality. The overlap between polythelia, polycystic kidney disease with adenocarcinoma in the upper pole. The nephrocutaneous defects and renal malignancy showed a peculiar ipsilaterality. The overlap between polythelia, polycystic kidney, and renal adenocarcinoma may provide a further clue to the embryonal origin of this cancer.

A gene for ulnar-mammary syndrome maps to 12q23-q24.1

Ulnar-mammary syndrome (UMS) is an autosomal dominant disorder characterized by posterior limb deficiencies or duplications, apocrine/mammary gland hypoplasia and/or dysfunction, abnormal dentition, delayed puberty and genital anomalies. We report the mapping of a gene causing UMS to chromosome 12q23-24.1. Linkage analysis generated a positive lod score of 6.21 at theta = 0.00 with the marker D12S79, and recombinants bracket the UMS gene to a 21 cM region. This region contains a locus for Holt-Oram syndrome (HOS) suggesting that the genes for UMS and HOS may be allelic or closely linked. The identification of the gene causing UMS will be an important step toward understanding the molecular mechanisms that control limb and apocrine gland development.

Ectopic breast tissue, supernumerary breasts, and supernumerary nipples

This article will review the embryology, clinical presentation, diagnosis, treatment, and clinical significance of ectopic breast tissue, supernumerary breasts, and supernumerary nipples. These structures most commonly develop along the embryonic "milk line." Supernumerary nipples can be identified at birth, whereas ectopic breast tissue becomes noticeable only after hormonal stimulation, usually during puberty, pregnancy, or lactation. Axillary ectopic breast tissue may provide a diagnostic challenge, as other benign and malignant lesions occur in this area. Fine needle aspiration is a useful tool. Ectopic breast tissue is subject to the same pathologic events that occur in normally positioned breasts. Excision may be required for diagnosis, treatment of symptoms, or cosmesis. Supernumerary nipples do not themselves pose diagnostic or symptomatic problems, but evidence suggests that they are markers for associated conditions, most notably urologic malformations or urogenital malignancies.

[An improved technique for preserving the nipple sensation in McKissock reduction mammaplasty]

An improved technique for preserving the nipple sensation in McKissock's reduction mammaplasty is described. Altogether four patients (seven breasts) have been operated on, and the primary results are highly satisfactory. The advantages of this technique are as followings: 1) The fourth lateral cutaneous nerve of the thorax, which mainly innervates the nipple, is preserved. All the patients retain the tactile sensation and the erectile reaction of the nipple after mammaplasty. 2) The operation is so modified that the suture line is smooth and has less tension. 3) The procedure ensures that both breasts are symmetrical after the operation.

Case report: breast hamartoma: MR findings

We report a case of breast hamartoma which was diagnosed by magnetic resonance (MR) imaging and describe the MR features of this lesion. There was a perfect correlation between the findings at MR imaging and the macroscopic appearance of the tumor.

Graft of breast tissue for correction of congenital asymmetry

This represents a case of a graft of autogenous breast gland from the enlarged side to augment the hypoplastic breast in cases of congenital asymmetry. Long-term consequences of this transfer and the thickness of the transferred gland that could be used remain unknown. It was with the patient's wishes and agreement to close follow-up that we undertook this approach to see if we could find a one-step procedure for correction of asymmetry without the use of either foreign material or flap. Mammogram at 2 years is normal.

[Reduction mammaplasty and mastopexy with a circumareolar incision]

Since 1990, we have done reduction mammaplasty and mastopexy on 22 patients using the circumareolar incision method. The advantages of the operation are as follows: simple design, less operative trauma, the possibility of performance under local anaesthesia, lactation preserved, good appearance with inconspicuous scar.

[Reduction mammaplasty using glandular pedicle]

A new technique for reduction mammaplasty with a glandular pedicle was designed based on the anatomical study of the vascular supply to the breast. The features of the procedure include using a pyramidal glandular pedicle that is reliably vascularized and definitely placed, maintaining a thin layer of parenchyme attached to the flap and the modified invert "T" closure. Clinical applications provided aesthetic and safe results of reliable nipple-areola survival, simplicity in breast mound creature and preservation of nipple sensitivity and the possibility of nursing function as well as less complications.

[Non-hypertrophic breast ptosis: classification and surgical treatment]

Non-hypertrophic breast ptosis are common diseases. Various degree of ptosis and different involutions of the breast tissue can condition the surgical treatment. Plastic surgery must provide the best surgical treatment in any case.

[Idiopathic unilateral hypoplasia of the breast]

Unilateral hypoplastic breast is a rare anomaly. The correction of the asymmetry is usually achieved by the use of breast implants or breast expanders. Sometimes the controlateral breast must be modified to gain a good symmetry.

Three-dimensional imaging of Poland's syndrome

Use of a three-dimensional CT scan as an adjunct for planning chest-wall and breast reconstruction in Poland's syndrome is presented with follow-up MRI with three-dimensional reformation to demonstrate the results of the implant reconstruction. The imaging techniques are capable of accurately portraying the three-dimensional tissue deficit and asymmetry. This imaging may assist in the choice of muscle transposition flaps and reconstructive technique.

ABC of breast diseases. Congenital problems and aberrations of normal breast development and involution

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Reduction and augmentation mammoplasty

Women seek reduction mammoplasty for alleviation of their symptoms of mammary hypertrophy, which may include upper back and neck pain, strain, or muscle spasm. Many of these women also desire an improvement in their appearance. Augmentation mammoplasty is sought by women for enlargement of the breasts and to attain a well-proportioned figure. Women who have experienced postpartum involution of the breasts request augmentation mammoplasty to regain the size and shape of their breasts prior to pregnancy. The historical background of these procedures, preoperative evaluation, and technical considerations are presented.

[Breast pathology in adolescence. Diagnostic problems]

Breast pathology, during adolescence, shows a typology like that in adults but with a completely different incidence. We observed 472 patients aged between 12 and 19 years in Senology Center of II Clinic of Obstetrics and Gynecology from 1984 to 1992. The most frequent pathologies diagnosed were: fibroadenomas (in the variety simple, phylloides, giant), cysts (simple and apocrine cysts); lower incidence for congenital anomalies, mastitis, mammary secretion caused by ductal hyperplasia or intraductal papilloma, lipoma. No incidence of cancer was detected. Echography was the principal diagnostic method for those patients who showed, at the clinical examination, a lump or palpable abnormalities. Mammography in this period does not affect the diagnoses and can be potentially harmful due to the exposure at X rays on such a sensible tissue.

Scalp-ear-nipple syndrome: additional manifestations

Scalp-ear-nipple (SEN) syndrome is a rare, autosomal dominant condition that causes aplasia cutis congenita of the scalp, alteration of the shape of the external ear, and hypoplasia of the nipple. Women in a new family, the fifth to be described, had virtually complete aplasia of the breast and a small skin dimple without any pigmentation instead of a normal nipple, although other affected women had normal breast and nipple development. Dental changes included widely spaced or missing secondary teeth; the ears were cupped or folded and stood out from the head, axillary apocrine secretion and axillary hair growth were reduced; and finger nails were brittle. There was no generalized abnormality of sweating. Some patients had partial syndactyly of the 3rd and 4th fingers, and complete cutaneous syndactyly of the 2nd and 3rd toes. and 3rd toes.

Mammary-like glands of the vulva and their disorders

Supernumerary mammary glands derived from rudiments of the embryonic milk lines or mammary ridges in the vulva are considered a source of a series of unusual tumors resembling lesions of the breasts. This phenomenon was reevaluated in light of recent observations of mammary-like anogenital glands (MLG), which are a normal constituent of the vulva and appear to be closely related to eccrine glands. An analysis of the literature reveals that the concept of "milk lines" originated in a mixture of phylogenetic and ontogenetic theories at the beginning of this century and was not supported by observations in human embryos, which show that primordia of the mammary glands do not extend beyond the axillary-pectoral area. The breasts and the vulva are so widely separated by time and space that the vulvar MLG can not be derived from the mammary ridges or milk lines. The profile of the MLG, which can also reveal some eccrine or apocrine features, makes these glands the most likely source of a series of lesions occurring in the anogenital region and comprising lactating glands, lactating adenoma, fibroadenoma, hidrocystoma, hidradenoma papilliferum, and most cases of extramammary Paget's disease and invasive adenocarcinoma.

[Tissue expansion in mammary reconstruction and asymmetry. Apropos of 24 prostheses]

Based on a 24 mammary expansion implants performed in 14 cases of deferred breast reconstruction and in 7 cases of asymmetry, the authors analyze their results and indications according to data reported in the recent literature data. In breast reconstruction, expansion represents a relatively simple surgical procedure allowing an increase of local tissues without any additional scars. Its indications correspond to the gap left between simple prosthesis and musculo cutaneous flaps and are based on a clinical analysis of the volume and quality of mammary tissues considering that radiotherapy constitutes more factor of morbidity than a real contra-indication. A strict selection of patients allows reduction of the complications (6% prosthesis extrusions and 6% contractures in this series) that remains quite high (30%) in the literature. Based on two main operative steps, the reconstruction needs, in the great majority of cases, several complementaries operative sequences increasing to 2.4 in their series, and to 2.6-2.8 the average number of operative steps in literature. For breast asymmetry, expansion was correlated in this series to a higher incidence of complications and especially capsular contractures, leading to a limitation of their indications to cases in which the benefit is maximal in relation to an important glandulocutaneous deficit. These indications are in which hypoplasia with superointernal malposition of the nipple areola complex where the effect of expansion is maximal in the inferointernal mammary area and tubular and tuberous breasts, in which expansion allows a widening of the base of the breast and breaks the fibrous ring at the base of the breast.

Bilateral free flap breast reconstruction

Bilateral mastectomies are relatively frequent. Free flaps from the abdomen, buttock, and lateral thigh can be used for simultaneous or staged reconstructions. The more extensive surgery is well rewarded by the permanent and gratifying results achieved. For patients unsuitable for implants or who have had failed implant reconstructions, such autologous tissue reconstructions are important alternatives.

Congenital breast asymmetry: subjective and objective assessment

There is currently no standard objective method for the assessment of developmental breast asymmetry. The results of corrective surgery in 24 patients with congenital breast deformities were evaluated subjectively (symmetry scores by patients and panels of observers), and objectively (linear measurements of nipple position and stereophotogrammetrically determined breast volumes). The latter were obtained using a newly developed prototype computer based technique (Bodymap). This study is the first reported use of stereophotogrammetry in assessing results of surgery for the correction of congenital breast asymmetry. The results obtained, their clinical implications, and the usefulness of Bodymap in the objective measurement of breast asymmetry are discussed.

Hamartomas of the breast: six novel diagnostic features in three-dimensional thick sections

Fifteen hamartomas of the breast have been studied by dissecting microscopy of thick sections at a depth of 1.0 to 2.5 mm, and by conventional 5 microns deep sections. This combined approach has revealed six distinctive features, three in the parenchymal structure and three in the connective tissue components. Ducts (invariably of penetrating or arcuate configuration) and discrete lobules, neither of which are seen in lesions accepted as fibroadenomas, were invariably found. In one-third of hamartomas, up to 10% of the surface area was occupied by Herãti-style nodules composed of concentric rings of epithelium. In the hyaline interlobular connective tissue characteristic drifts of caraway seed-like fibrocytes, encasement of adipocytes by hyaline collagen, or spider-naevus vascular abnormalities were found in approximately half of the mammary hamartomas when examined in thick sections. Hitherto the positive diagnosis of hamartomas of the breast has relied on a combined clinical, radiological and pathological assessment. We suggest that the additional features described here, taken in conjunction with those already known, may facilitate the recognition of mammary hamartomas by histopathological examination alone.