Our surgical approach to treatment of congenital, developmental, and acquired breast asymmetries: a review of 30 cases

A Simple and Effective Intraoperative Technique for Correction of Severe Congenital Breast Asymmetry

BACKGROUND

One severe type of congenital breast asymmetry, with a hypoplastic breast on one side and a hyperplastic breast on the other side, has been recognized in the author's practice. Although breast augmentation, mastopexy, and breast reduction used separately or in combination are the most common procedures performed to correct congenital asymmetrical breasts, an effective approach for the correction of such a congenital breast asymmetry has not been established in the literature. In this article, a simple and effective intraoperative approach is described for correction of severe congenital breast asymmetry.

METHOD

Breast augmentation with an implant for the hypoplastic side and mastopexy or small breast reduction for the hyperplastic side were performed. Symmetry was achieved intraoperatively by an implant for breast augmentation on the hypoplastic side and mastopexy or small reduction, determined by a tailor-tacking technique, on the hyperplastic side.

RESULTS

In the past 2 years, a total of 4 patients with severe congenital breast asymmetry was operated on by the author with this established approach. All patients were pleased about their symmetry and cosmetic outcome without any surgical complications. The resulted breast scars are minimal and well tolerated by patients. No revision or subsequent surgery has even been needed during follow-op.

CONCLUSION

Correction of severe congenital breast asymmetry is not an easy task and can be difficult. This simple and effective intraoperative approach provides a relatively easy and logical way as a 1-stage procedure for this subgroup of patients with symmetrical and cosmetically pleasing outcome.

3D Volume Assessment as an Objective Tool in Breast Asymmetry Management

Throughout history, the female breast has been a universal symbol of femininity. The breast's normal symmetrical appearance is an important aspect of the female form. Female breasts are not perfectly symmetrical by nature, and minor differences in shape or volume are common. However, it can be psychologically distressing for patients and affect their perception of their bodies. Aesthetic breast surgeons strive to minimize these differences in order to make them more acceptable to patients. This study aimed to provide an objective and practical strategy for effectively managing breast asymmetry.

Method

This study was conducted between November 2017 and September 2021 on 20 female patients seeking breast asymmetry correction at Kasr El-Ainy Hospital. All patients had volumetric breast assessment using a three-dimensional (3D) imaging system (3D LifeViz, Quantificare system), and MRI breast volumetry was done preoperatively in all patients. The patients were managed with different single-stage surgical procedures depending on the objective assessment of the volume differences between their breasts.

Results

Breast volume assessment using the 3D camera was done preoperatively and postoperatively. The preoperative mean volume difference was 159.45 cm³, and the postoperative mean difference was 16.75 cm³ with an overall reduction in mean volume difference of 89.5%. Comparing the 3D camera and MRI in assessing breast volume difference showed no statistical significance.

Conclusions

The 3D technology is a useful objective tool to augment the surgeon's experience. It helped achieve an 84.57% reduction in volume difference in managing breast asymmetry with a single-stage procedure.

Comparative Morphological Evaluation of Young Women's Breast-Bra Reshaping by Different Bra Cups

Female breasts are regarded as a factor reflecting women's morphological beauty. An appropriate bra can fulfill aesthetic needs, thus boosting self-esteem. This study proposed a method to analyze young women's breast-bra morphological variations between two identical bras with different bra cup thicknesses. The 3D surface scan data of 129 female students who were braless and wore a thin bra (13 mm) and a thick bra (23 mm) were analyzed. Integral sections of the breasts and bra were cut at a fixed thickness of 10 mm, and slice maps were derived. Morphological parameters were extracted in braless and the two bra conditions. The variations in breast-bra shape caused by different thicknesses of bra cups were evaluated by quantifying breast ptosis, gathering, and breast slice area. The results showed that the thin bra lifted the breasts by 2.16 cm, whereas the thick bra decreased breast separation, gathering the breasts and moving them 2.15 cm laterally towards the center of the chest wall. Moreover, prediction models constructed using the critical morphological parameters were used to characterize breast-bra shape after wearing the provided bras. The findings lay the groundwork for quantifying the breast-bra shape variation caused by different bra cup thicknesses, allowing young females to choose optimally fitting bras to achieve their desired breast aesthetics.

The use of Fat-Augmented Latissimus Dorsi (FALD) flap for male Poland Syndrome correction: a case report

We present a 23-year-old male patient with severe PS, characterized by marked left thoracic wall deformity. Reconstruction was performed using the Fat-Augmented Latissimus Dorsi flap, which was fixed to the chest wall hollowing corresponding to where the pectoralis major muscle was missing. Patient was satisfied with final aesthetic and functional result.

Review of Tuberous Breast Deformity: Developments over the Last 20 Years

Tuberous breast (TB) deformity is a condition characterized by alterations in breast morphology and tissue structure with high prevalence in the general population. The literature provides sparse descriptions of TB, as not many investigations on the condition have been conducted. The aim of this review was to analyze and provide a holistic overview on the morphological characteristics of the TB.

Methods

A review of current literature was performed using the PubMed database from 2001 to 2021. The key words used for the review included "tuberous breast," "constricted breast," and "stenotic breast." We included articles that analyzed the anatomic and histologic characteristics of TB.

Results

From 213 articles, only 42 met the inclusion criteria. A total of 171 articles were excluded, as they were letters, not related to the condition, or were written in a foreign language. The studies in this review drew on hypothesis on the embryological origin of TB and analyzed the composition of TB tissues, consisting in a constricting fibrous ring, made of longitudinally arranged collagen and elastic fibers. Furthermore, the review reports the different anatomical and surgical classifications, as well as the various surgical corrective procedures developed throughout history up to 2021.

Conclusion

The review describes all etiological, epidemiologic, anatomical, histological, and surgical characteristics of tuberous breast.

Surgery of congenital breast asymmetry-which objective parameter influences the subjective satisfaction with long-term results

PURPOSE

Congenital breast asymmetry is a serious gynecological malformation for affected patients. The condition hits young women in puberty and is associated with socio-esthetic handicap, depression, and psychosexual problems. Surgical treatment is usually early in the patient's lifetime, so a long-term sustainable solution is important. Although postoperative outcome has been evaluated in several studies before, this study is the first to analyze which objective parameters have the greatest influence on subjective satisfaction with long-term results.

METHODS

Thirty-four patients diagnosed with congenital breast asymmetry that underwent either lipofilling or implant therapy between the years of 2008 to 2019 were examined. On average, our collective comprised patients seven years after surgery. Data were mainly gathered through manual measurements, patient-reported outcome measures (Breast Q^™), and breast volumetry based on 3D scans (Vectra^® H2, Canfield Scientific).

RESULTS

Among all analyzed parameters, only areolar diameter correlated significantly negatively with the subjective outcome satisfaction of the patient. Regarding the subjective assessment of postoperative satisfaction with similarity of the breasts, again the mean areolar diameter, but also the difference in areolar diameter and breast volume between the right and left breasts correlated significantly negatively.

CONCLUSION

Areolar diameter was revealed as being a significant factor influencing subjective long-term satisfaction in breast asymmetry patients. Moreover, 3D volumetry proves to be an effective tool to substantiate subjective patient assessments. Our findings may lead to further improvements to surgical planning and will be expanded in further studies.

Breast Asymmetry, Classification, and Algorithm of Treatment: Our Experience

BACKGROUND

In the literature, several classifications of breast asymmetries and treatment protocols have been proposed over time, which are mainly based on etiological or morphological characteristics of the deformity. The aim of this study was to present our new classification, based on patient's self-consciousness of breast asymmetry, a simple and reliable treatment algorithm is also presented.

METHODS

The case series included 343 patients treated between January 2006 and January 2015. Only patients presenting with developmental breast asymmetries were included in the study. All patients underwent prior classification in three groups based on the patient's degree of awareness of their asymmetry. A specific treatment algorithm was associated with each group according to breast size, grade of ptosis, and patient's desire. At the 48-month follow-up appointment, patients completed an anonymous questionnaire that addressed satisfaction with breast shape, size, and symmetry, scar appearance, body perception, self-esteem, perceived attractiveness, intimate life, and overall feelings about their breasts.

RESULTS

Mean patient age was 24.6 years (range 18-57 years). Mean follow-up was 54.4 months (6 months to 9 years). At the 48-month follow-up, 66.7% of the patients completed a visual analog scale (VAS) satisfaction questionnaire. An overall satisfaction rate of 77.0% was reported, and a statistically significant difference in the distribution of the overall satisfaction between groups was found. No patient expressed complete dissatisfaction.

CONCLUSIONS

The proposed classification and the surgical algorithm is a simple, applicable, and reliable method to assess and treat breast asymmetries with a high satisfaction rate as confirmed from our results.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

When Is Teenage Plastic Surgery versus Cosmetic Surgery Okay? Reality versus Hype: A Systematic Review

Plastic surgery in teenagers has become popular in past decades because of an increase in self-awareness and desire to "fit in" with their peers. In 2016, over 229,551 cosmetic procedures were performed in patients who are younger than 19 years. The trend of plastic surgery in adolescents is increasing, and it is important for plastic surgeons to perform safe and appropriate procedures in this group. To this date, there is a myriad of literature on the psychological and ethical issues concerning plastic surgery in teenagers. However, studies regarding the safety of performing plastic surgery in this population are scarce. The rationale for this article is to study this issue in depth by means of a systematic review. The authors discuss the current indications, safety, patient satisfaction, and ethical considerations of teenage plastic surgery and make recommendations for future studies on this important area.

A Nonsurgical Approach to Adolescent Breast Asymmetry Using External Prostheses

PURPOSE

Currently, there are few nonsurgical treatment options for pediatric patients with developmental breast asymmetry. Our group established a partnership with a prosthetic unit within a local oncology center to provide custom-fit breast prostheses for young women with breast asymmetry. The purpose of this study was to describe the effect of this experience on patients' self-esteem and body image.

METHODS

Patients were administered an anonymous satisfaction survey at least 1 month after their first fitting at the prosthetic unit. The survey was designed to evaluate body image, self-esteem, as well as social and emotional well-being before and after treatment. Thematic analysis was used to assess their experiences.

RESULTS

Seventeen patients, aged 12-19 years, visited the prosthetic unit and subsequently completed the retrospective survey. After using the breast prostheses, 14 (82.4%) patients reported an improvement in body image and 12 (70.6%) patients reported an improvement in self-esteem. Benefits pertaining to three emergent themes were revealed: "body wholeness/symmetry," "body image and psychological well-being," and "esthetic outcome."

CONCLUSIONS

Results from the survey demonstrate the ease and efficacy of a form of nonsurgical treatment for adolescent breast asymmetry. Our partnership with an adult oncology center can serve as a national model to support the development of similar treatment programs. Existing resources that have been previously used only for adult breast cancer survivors can be effectively applied to the adolescent population to ameliorate the negative psychological effects of breast asymmetry.

Breast Reduction in the Burned Breast

Mammary hypertrophy can occur in the postburn breast. Patients with burned breasts exhibit the same symptoms of symptomatic macromastia as patients with unburned breasts. The extent of the deformity, the location of the deformity, and the status of the surrounding soft tissue are all assessed before embarking on any surgical plan, which then proceeds in a conservative stepwise fashion. Although many plastic surgeons are reluctant to operate on burned breasts for fear of devascularizing the skin graft or nipple areolar complex, reduction mammaplasty in this group of patients is safe and carries minimal risk if key concepts are followed.

Natrelle Silicone Breast Implant Follow-up Study: Demographics, Lifestyle, and Surgical Characteristics of More Than 5000 Reconstruction Subjects

BACKGROUND

A large, multicenter, 10-year observational study is comparing the long-term safety and effectiveness of Natrelle silicone breast implants versus saline implants or national norms.

METHODS

Women who underwent primary augmentation, revision-augmentation, primary reconstruction, or revision-reconstruction were invited to participate. Enrolled subjects had completed surgery and received one implant or matching implants. Baseline demographics, health, lifestyle, and surgical characteristics are presented here for adult subjects who underwent primary reconstruction or revision-reconstruction.

RESULTS

Of 5637 subjects who underwent reconstruction surgery (86.7% primary reconstruction; 13.3% revision-reconstruction), 5407 received silicone implants and 230 received saline implants; 72.9% received bilateral implants. Silicone implants were used in 96.2% who underwent primary reconstruction and in 94.1% who underwent revision-reconstruction. Median age was about 3 years lower in those who underwent primary reconstruction versus revision-reconstruction. Most subjects were white nonsmokers and had attended college. Hispanic subjects were more likely to receive saline implants for primary reconstruction. Across groups, the most common characteristics by implant type or procedure included smooth-surface implants (90.8%), mastectomy scar site (69.7%), and partial (59.2%) or complete (33.9%) submuscular placement. Implant size was larger for revision-reconstruction versus primary reconstruction, and incision size was larger for silicone versus saline implants in subjects undergoing primary reconstruction.

CONCLUSIONS

This study provides an unprecedented look at a large subject sample. The data offer surgeons an opportunity to make informed decisions regarding the most appropriate implant attributes and surgical approaches for women who desire breast implants for primary or revisionary breast reconstruction.

Evidence-based evaluation technique to assess augmentation mammaplasty results: a simple method to objectively analyze mammary symmetry and position

BACKGROUND

Despite the great variety of mammaplasty techniques, outcome assessment remains a challenging issue.

OBJECTIVES

The authors devised an objective method to evaluate mammary symmetry based on statistical analysis of objective manual breast measurements and validated the method by applying it to results of a randomized controlled trial on the correction of breast asymmetry.

METHODS

Sixty consecutive patients with hypoplastic breasts and small-volume asymmetry were enrolled in the study and randomly assigned to 1 of 2 groups. One group received a fixed-volume implant in 1 breast and an adjustable-volume implant in the other. The other group received 2 fixed-volume implants of different sizes. The differences in specific breast and chest measurements, obtained before surgery and during follow-up, were analyzed statistically with the Wilcoxon signed rank test.

RESULTS

Correction of the asymmetry resulted in the reduction of the differences between left and right values for each specific breast measurement. Placement of an adjustable implant on 1 side yielded better symmetry than placement of 2 fixed-volume prostheses of different sizes. Patient and physician satisfaction was high for both groups.

CONCLUSIONS

This objective analysis of clinical parameters enables comparing results for different patients in large clinical trials and for the same patient at different follow-up periods.

LEVEL OF EVIDENCE

3.

Tabbed tissue expanders improve breast symmetry scores in breast reconstruction

Background

Achieving symmetry is a key goal in breast reconstruction. Anatomically shaped tabbed expanders are a new tool in the armamentarium of the breast reconstruction surgeon. Suture tabs allow for full control over the expander position and thus inframammary fold position, and, in theory, tabbed expanders mitigate many factors responsible for poor symmetry. The impact of a tabbed expander on breast symmetry, however, has not been formally reported. This study aims to evaluate breast symmetry following expander-implant reconstruction using tabbed and non-tabbed tissue expanders.

Methods

A chart review was performed of 188 consecutive expander-implant reconstructions that met the inclusion criteria of adequate follow-up data and postoperative photographs. Demographic, oncologic, postoperative complication, and photographic data was obtained for each patient. The photographic data was scored using a 4-point scale assessing breast symmetry by three blinded, independent reviewers.

Results

Of the 188 patients, 74 underwent reconstruction with tabbed expanders and 114 with non-tabbed expanders. The tabbed cohort had significantly higher symmetry scores than the non-tabbed cohort (2.82/4±0.86 vs. 2.55/4±0.92, P=0.034).

Conclusions

The use of tabbed tissue expanders improves breast symmetry in tissue expander-implant-based breast reconstruction. Fixation of the expander to the chest wall allows for more precise control over its location and counteracts the day-to-day translational forces that may influence the shape and location of the expander pocket, mitigating many factors responsible for breast asymmetry.