Amazia with midface anomaly: case report

Unilateral Amazia

Amazia refers to a condition where one or both of the mammary glands are absent in which the nipple and areola remain present, breast parenchyma is absent, and it may be unilateral or bilateral. We present a case of unilateral amazia. On literature review, very few cases were reported.

Bilateral congenital amazia: a case report and systematic review of the literature

BACKGROUND

Congenital breast anomalies present challenging management decisions to the plastic surgeon. One must consider the optimal age of reconstruction as well as the ideal surgical technique. Amazia, a very rare condition characterised by a complete lack of breast tissue in the presence of a nipple areolar complex (NAC), is one such congenital breast anomaly.

METHODS

A comprehensive systematic review of the literature was performed to examine the various approaches to reconstruction of congenital breast anomalies. From this review, the data compiled included patient demographics and operative details, including type of reconstruction, treatment of the contralateral breast and treatment of the NAC. A case of bilateral amazia is also reported.

RESULTS

Of 178 articles, 13 ultimately met the inclusion criteria and 54 individual patient reconstructions were identified from these papers. At the time of reconstruction, the patients were in the range of 13-54 years, with an average age of 27.6 years. Prosthetic and autologous reconstructions were equally represented (19 patients each, 35.2%; Table 2). Autologous reconstruction with prosthesis was slightly less common (15 patients, 27.8%). One patient was reconstructed using autologous lipo-augmentation only. Of the 36 cases in which the approach to the NAC was addressed, most (66.7%) were not reconstructed.

CONCLUSIONS

Amazia is a very rare congenital anomaly of the breast. This systematic review of the literature highlights the need for better reporting and examination of this type of data to allow for future study and to better advise on decision making regarding the timing of reconstruction, surgical technique and the approach to the NAC.

Isolated unilateral amazia: an exceptional breast anomaly

BACKGROUND

Amazia is a rare breast anomaly. It consists of the absence of the mammary gland, with normal nipple-areola complex. It usually presents associated with a syndrome and it can be diagnosed during infancy or at the beginning of puberty.

CASE

Here we report a case of a 13-year-old female with a late diagnosis of unilateral amazia. No distinctive body or anatomic abnormalities were found. She was referred for surgical reconstruction.

COMMENTS

Amazia is an uncommon entity with a lack of incidence information in the literature. Early diagnosis and proper treatment are essential to avoid body image complications, especially among adolescent women.

Congenital Absence of a Teat in a Japanese Black Heifer

A case of Japanese Black heifer with a congenital absence of teat (athelia) was observed at Highashi-Hiroshima Agricultural High School, Hiroshima Prefecture, Japan. The heifer was born after transfer of embryo from Japanese Black cattle. The sire of the heifer was a proven Japanese Black. The birth weight of the heifer was 27 kg. On physical examination of the heifer at 21 months after birth, the teat at fore left was absent and the remaining three teats were normal in shape without any physical abnormalities. Per rectal palpation of the genital organs revealed the normal cervix and uterine horns. It was difficult to palpate the ovaries due to the fat around the organs. Blood samples were taken for cytogenetic and DNA testing. The heifer had normal chromosomal set. The heifer was culled due to its mammary abnormality. This might be the first to report a case of congenital absence of a teat in Japanese Black heifers.

Congenital bilateral amazia associated with bilateral choanal atresia

Congenital absence of breast development is a very rare abnormality. It may present as an isolated finding or it may be accompanied by other congenital anomalies. Here we report on a 13.5-year-old girl presented to our pediatric endocrinology clinic because of lack of breast development. She had pubarche since the age of 10 years and was regularly menstruating since the age of 12 years. The patient's medical history was positive for bilateral complete choanal atresia that was diagnosed and corrected soon after birth. Physical examination was unremarkable except for bilateral amazia, that is, absence of palpable breast tissue and hypoplastic areolae, whereas both nipples were formed. Renal ultrasonography and chest radiography were normal. The coexistence of congenital bilateral amazia and bilateral complete choanal atresia suggests that these rare disorders may be related etiologically. The patient is scheduled for breast augmentation.