1
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Surcel ES, Merkkola-von Schantz PA, Öhman H, Kauhanen SC. Long-term results of the tuberous breast: What to expect after the primary correction process? Scand J Surg 2024; 113:246-253. [PMID: 38742668 DOI: 10.1177/14574969241250213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND AIMS Tuberous breast is a rare anomaly affecting the development of mainly the female breast. It presents with varying degrees of hypoplasia in the breast base and skin. In some cases, herniation and widening of the areola is observed. The condition constitutes a great challenge for the reconstructive surgeon. In this study, the surgical cascades of implant and lipofilling corrections were compared with a focus on the need for re-interventions. METHODS In total, 129 patients whose treatment regimen started between January 2010 and October 2020 were included in this study. Patients were categorized into two groups based on the volume correction method used (lipofilling versus implant). RESULTS In 35 (27%) patients (41 breasts), breast volume increasement was executed with an implant, while 94 (73%) patients (169 breasts) underwent volume increasement with lipofilling. The mean number of operations during the primary correction process was 1.2 (range 1-5) for the implant group and 2.4 (range 1-5) for the lipofilling group. When assessing the need for re-operations within 5 years after completing the primary correction, 46% of patients in the implant group needed further surgeries, while the corresponding proportion for the lipofilling group was 21% (p = 0.04). There were six major complications, all of them in the implant group. CONCLUSION Implant-based reconstruction is associated with more revision surgeries and major complications compared to autologous lipofilling corrections. Lipofilling offers a more durable result with less re-operations over time despite initial sequential primary surgeries.
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Affiliation(s)
- Elena S Surcel
- Department of Plastic and Reconstructive Surgery University of Helsinki and Helsinki University Hospital PO Box 266 Helsinki 00029 HUS Finland
| | - Päivi A Merkkola-von Schantz
- Department of Plastic and Reconstructive Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Öhman
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Susanna C Kauhanen
- Department of Plastic and Reconstructive Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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2
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Knoedler S, Knoedler L, Kauke-Navarro M, Alfertshofer M, Obed D, Broer N, Kim BS, Könneker S, Panayi AC, Hundeshagen G, Kneser U, Pomahac B, Haug V. Quality of life and satisfaction after breast augmentation: A systematic review and meta-analysis of Breast-Q patient-reported outcomes. J Plast Reconstr Aesthet Surg 2024; 95:300-318. [PMID: 38945110 DOI: 10.1016/j.bjps.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Breast augmentation ranks among the most popular plastic surgery procedures. Yet, reports on post-operative patient-reported quality of life (QoL) and satisfaction remain conflicting. METHODS A systematic review was conducted following the PRISMA guidelines. Three databases were searched for eligible studies that reported pre-and/or post-operative Breast-Q™ augmentation scores for patient QoL (psychosocial, sexual, and physical well-being) and/or satisfaction. RESULTS A total of 39 studies (53 patient cohorts and 18,322 patients) were included in the quantitative synthesis. The pairwise meta-analysis revealed significant improvements in patient-reported psychosocial (MD: +38.10) and sexual well-being (MD: +40.20) as well as satisfaction with breast (MD: +47.88) (all p < 0.00001). Physical well-being improved slightly after breast augmentation (MD: +6.97; p = 0.42). The single-arm meta-analysis yielded comparable results, with Breast-Q™ scores in psychosocial and sexual well-being as well as satisfaction with breast increasing from 37.2, 31.1, and 26.3 to 75.0, 70.6, and 72.7, respectively (all p < 0.00001). Physical well-being improved by 8.1 (75.8 pre-operatively to 83.9 post-operatively; p = 0.17). Subgroup analyses highlighted higher QoL and satisfaction following breast augmentation for purely esthetic purposes and alloplastic mammaplasty. Although patient-reported physical and sexual well-being increased in the long term, psychosocial well-being was the highest in the short term. CONCLUSION Patient satisfaction with breast, psychosocial, and sexual well-being increased significantly after breast augmentation. In contrast, patient-reported physical well-being yielded ambivalent results, varying by mammaplasty technique and post-operative follow-up time. Plastic surgeons should be sensitized about our findings to refine eligibility criteria and gain a deeper understanding of the patients' perceived surgical experience. PROSPERO TRIAL REGISTRATION NO CRD42023409605.
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Affiliation(s)
- Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Leonard Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Michael Alfertshofer
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Munich, Munich, Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Sören Könneker
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Adriana C Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Gabriel Hundeshagen
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Valentin Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
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3
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Papadopoulos S, Colpaert SDM, Vidovic G, Moysiadis T, Athanasiadis AP, Tio J, Abdallah A. Correction of the Tuberous Breast with Fat Grafting and Implant: Techniques, Evaluation with BREAST-Q, and Preliminary Results. Aesthetic Plast Surg 2024:10.1007/s00266-024-04032-y. [PMID: 38760537 DOI: 10.1007/s00266-024-04032-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/22/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The correction of tuberous breast deformity with fat grafting has gained popularity in recent years, but it remains unclear whether this new technique can produce patient satisfaction levels comparable to those achieved with implant-based correction. METHODS This study aimed to compare patients' satisfaction and quality of life using the BREAST-Q questionnaire after correction of tuberous breast deformity with fat grafting and implants. Twenty-four patients (36 breasts) were included in our study. Thirteen patients (15 breasts) had a correction with lipofilling (mean 2.67 interventions) and 11 patients (21 breasts) had an implant-based correction (mean 1 intervention). RESULTS Both fat and implant treatments showed statistically significant improvements in breast satisfaction (p value=0.001, 0.002, respectively), psychosocial (p value=0.003, 0.003, respectively), and sexual satisfaction (p value=0.008, 0.002, respectively) between the pre-treatment and post-treatment stages. However, the only statistically significant differences between the treatments were observed in the physical condition pre-treatment (p value=0.008) and sexual condition post-treatment (p value=0.030). The outcome of both treatments was not statistically different. Furthermore, the outcome exhibited a statistically significant positive linear relationship with breast satisfaction for both treatments. CONCLUSIONS This study suggests that lipofilling can achieve breast and outcome satisfaction comparable to that of implants, although this parity in results comes at the cost of more interventions. These preliminary results lend support to the notion that, as surgeons have access to two equally effective techniques, it is crucial to provide appropriate guidance to patients to ensure their satisfaction. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sarantos Papadopoulos
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Munckelstrasse 27, 45879, Gelsenkirchen, Germany.
| | | | - Goran Vidovic
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Gelsenkirchen, Germany
| | - Theodoros Moysiadis
- Department of Computer Science, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus
| | - Apostolos P Athanasiadis
- 3rd Department of Obstetrics and Gynecology, Medical School, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Joke Tio
- Department of Obstetrics and Gynecology, Breast Center, Muenster University, Muenster, Germany
| | - Abdallah Abdallah
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Gelsenkirchen, Germany
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4
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Donnenfield JI, Nuzzi LC, McNamara CT, White AG, Labow BI. The Impact of Tuberous Breast on Adolescents: A Cross-sectional Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5530. [PMID: 38268714 PMCID: PMC10807874 DOI: 10.1097/gox.0000000000005530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 01/26/2024]
Abstract
Background Tuberous breast deformity is a nondiagnostic, descriptive term for a congenital breast difference that becomes apparent at puberty. Although the negative physical and psychosocial effects of macromastia and breast asymmetry are established, no studies to date have explored the impact of tuberous breasts on health-related quality of life (HRQoL) outcomes using a robust sample size. Methods In this cross-sectional study, HRQoL surveys were administered to adolescent women with tuberous breasts and healthy female controls, aged 12-21 years. Surveys included the Short-Form 36v2, Rosenberg Self-Esteem Scale, and Eating Attitudes Test-26. Demographics were compared, and linear regressions were fit to determine the effect of tuberous breast deformity on survey scores, with body mass index (BMI) category as a covariate. Results Thirty-four patients with tuberous breasts and 264 controls participated. Patients with tuberous breasts had higher mean BMI than controls (P < 0.05). After adjusting for differences in BMI category, patients with tuberous breasts scored lower than controls on the Rosenberg Self-Esteem Scale and in Short-Form 36v2 domains related to physical and psychological health (P < 0.05, all). Compared with controls, patients with tuberous breasts had a higher mean score on the Eating Attitudes Test-26 (P < 0.05). Conclusions Tuberous breast deformity may negatively impact patients' physical and psychosocial HRQoL and increase their risk for disordered eating and higher BMIs. It is imperative that healthcare providers and third-party payors understand tuberous breast deformity is not just a cosmetic issue and tailor care and coverage policies accordingly.
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Affiliation(s)
- Jonah I. Donnenfield
- From the Adolescent Breast Center, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Laura C. Nuzzi
- From the Adolescent Breast Center, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Catherine T. McNamara
- From the Adolescent Breast Center, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Ava G. White
- From the Adolescent Breast Center, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Brian I. Labow
- From the Adolescent Breast Center, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
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5
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Alvaro AI, Willet JW, Dounas GD, Jeeves A, Lodge M, Javed MU. A Systematic Review of Outcomes and Complications of Tuberous Breast Surgery. Aesthet Surg J 2023; 43:NP1001-NP1009. [PMID: 37439225 DOI: 10.1093/asj/sjad229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Tuberous breast is a complex congenital breast anomaly that can be challenging to correct surgically. OBJECTIVES The authors conducted a systematic review with pooled analysis of data, with the aim of determining the effectiveness and complications related to operative management of the deformity. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were adopted in performing this systematic review. A simplified classification system for tuberous breast deformity was developed to accurately compare data and guide analysis. RESULTS The review identified 38 studies, reporting a total of 897 patients undergoing tuberous breast surgery. The mean age of patients was 24 years (range 13-53 years). Mean follow-up was 39 months. A combination of tissue rearrangement and implant augmentation was the most common technique (73% of patients) followed by fat transfer alone (9%). Breast implants were employed in 83% of patients. The mean implanted volume per breast was 263 cc. Fat grafting was performed in 13% of patients and mean volume of fat grafted per breast was 185 cc. An overall complication rate of 20% was reported. Subjective assessment of patient satisfaction was 99%, and the mean score on BREAST-Q for satisfaction with clinical outcome was 86.7. Future studies should focus on robust study designs including randomized and cohort studies, use of patient-reported outcome measures, and long-term follow-up. CONCLUSIONS The surgical techniques to correct tuberous breast deformity are safe, effective, and have a high satisfaction rate. Fat transfer has the capacity to provide promising results in treating tuberous breast deformity. LEVEL OF EVIDENCE: 4
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6
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Lonie S, Tavakoli K. An Algorithm for Correction of Mild Tuberous Breast Deformity in Augmentation Mammaplasty: Camouflage or Correct? Aesthet Surg J 2023; 43:NP878-NP887. [PMID: 37556836 DOI: 10.1093/asj/sjad255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Tuberous breast deformity (TBD) is a common abnormality, particularly in patients presenting for breast augmentation. Failure to correct each regional abnormality, including the inframammary fold, lower pole deficiency, nipple-areola complex widening or herniation, or any degree of ptosis, will result in exaggeration of the deformity and a poor aesthetic outcome. OBJECTIVES To describe an algorithm, including novel techniques, to address each region of mild TBD in patients undergoing breast augmentation. METHODS This is a retrospective review and description of the senior author's (K.T.) techniques for correction of early-stage TBD from 2016 to 2021. RESULTS One hundred forty-two patients underwent a stepwise approach to correct milder TBD features when undergoing breast augmentation. CONCLUSIONS The authors propose a regional algorithm for management of TBD, to allow mostly single-stage correction, except in cases with marked ptosis, severe asymmetry, or marked macroareola. LEVEL OF EVIDENCE: 4
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7
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Gentile P. Tuberous Breast, Deformities, and Asymmetries: A Retrospective Analysis Comparing Fat Grafting Versus Mastopexy and Breast Implants. Aesthetic Plast Surg 2023; 47:1683-1694. [PMID: 36161350 PMCID: PMC10581921 DOI: 10.1007/s00266-022-03089-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/27/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND The tuberous breast is considered a breast deformity characterized by varying degrees of herniation of the parenchyma, widened nipple-areolar complex (NAC), absence of the lower quadrants, and may involve several degrees of hypoplasia and asymmetry causing significant psychosocial distress. OBJECTIVES The paper aimed to compare the results obtained in patients suffering tuberous breast treated with fat grafting (FG), with those of patients treated with a mastopexy and silicone implants (M-SI) also analyzing the influence of breast and chest deformities (degrees of hypoplasia and tuberous breast, volume and NAC asymmetry, pectus excavatum, and carinatum) in the reconstructive outcomes. METHODS A retrospective, case-control study was conducted. Thirty-five patients affected by tuberous breast with several degrees of hypoplasia and asymmetry were treated with FG, comparing results with those of 30 patients treated with M-SI. Postoperative follow-up took place at 1, 3, 7, 12, 24, 48, weeks, and then annually for 2 years. RESULTS 77% (n = 27) of patients treated with two FG procedures showed excellent results after 1 year compared with the patients treated with only one M-SI procedure, who showed the same results in 73% (n = 22) of cases, but the naturalness and the satisfaction degree in the FG group were higher than that in the M-SI group (p < .0001 vs. M-SI group). CONCLUSIONS Patients treated with FG showed natural breasts without scars and excellent cosmetic results after two procedures. Patients treated with M-SI showed more evident and lasting results after only one procedure, presenting though scars and less natural 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Pietro Gentile
- Associate Professor of Plastic and Reconstructive Surgery, Department of Surgical Science, Tor Vergata" University, 00133, Rome, Italy.
- Scientific Director of Academy of International Regenerative Medicine & Surgery Societies (AIRMESS), 1201, Geneva, Switzerland.
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8
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Leite AT, Sabino-Neto M, Resende VCL, Veiga DF, Ferreira LM. Patient-Reported Outcomes after Subpectoral Breast Augmentation with Microtextured or Macrotextured Implants Using the BREAST-Q. Arch Plast Surg 2022; 49:352-359. [PMID: 35832157 PMCID: PMC9142250 DOI: 10.1055/s-0042-1748649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background
Breast augmentation with implants is the most commonly performed cosmetic plastic surgery in Brazil and worldwide. The aim of this study was to assess patient satisfaction and quality of life following subpectoral breast augmentation with either microtextured or macrotextured implants, using the BREAST-Q.
Methods
A prospective study was conducted with 40 women with hypomastia undergoing subpectoral breast augmentation. The patients were randomly allocated to two groups to receive either microtextured or macrotextured breast implants. All participants were assessed preoperatively (baseline) and after 2 and 4 months of surgery for quality of life and patient satisfaction with the surgical results, using the BREAST-Q augmentation module, a patient-reported outcome measure.
Results
The patients had a mean age of 28.9 ± 6.45 years. The microtextured (
n
= 20) and macrotextured (
n
= 20) groups were homogeneous for sex, age, education level, marital status, and number of children (
p
> 0.05). Both groups showed significant improvement in satisfaction with breasts (
p
< 0.001), psychosocial well-being (
p
< 0.001), and sexual well-being (
p
< 0.001) at the 2- and 4-month follow-up visits compared with baseline. The observed improvements were associated with high effect size values of 5.09, 3.44, and 3.90, respectively. In contrast, significant decreases from baseline in physical well-being scores (
p
= 0.001) were found 2 and 4 weeks after surgery in both groups.
Conclusion
Subpectoral breast augmentation with either microtextured or macrotextured breast implants improved satisfaction with breasts and quality of life in patients with hypomastia.
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Affiliation(s)
- Alice Teixeira Leite
- Graduate Program in Translational Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Miguel Sabino-Neto
- Division of Plastic Surgery, Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Daniela Francescato Veiga
- Division of Plastic Surgery, Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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9
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Lozito A, Vinci V, Talerico E, Asselta R, Di Tommaso L, Agnelli B, Klinger M, Klinger F. Review of Tuberous Breast Deformity: Developments over the Last 20 Years. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4355. [PMID: 35702542 PMCID: PMC9187173 DOI: 10.1097/gox.0000000000004355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- Alessia Lozito
- From the Humanitas Clinical and Research Center – IRCCS, Rozzano – Milan, Italy
| | - Valeriano Vinci
- From the Humanitas Clinical and Research Center – IRCCS, Rozzano – Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Eleonora Talerico
- From the Humanitas Clinical and Research Center – IRCCS, Rozzano – Milan, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luca Di Tommaso
- From the Humanitas Clinical and Research Center – IRCCS, Rozzano – Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Benedetta Agnelli
- From the Humanitas Clinical and Research Center – IRCCS, Rozzano – Milan, Italy
| | - Marco Klinger
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, Humanitas Clinical and Research Hospital, University of Milan, Milan, Italy
| | - Francesco Klinger
- University of Milan, Department of Health Sciences, Ospedale San Paolo, Milan, Italy
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10
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Papadopoulos S, Colpaert SDM, Goulis DG, Nigdelis MP, Grimbizis GF, Tio J, Abdallah A. Treating Anisomastia and Tuberous Breast with Fat Grafting: Technique and Evaluation of Outcomes Using BREAST-Q Surveys. Aesthetic Plast Surg 2021; 45:2729-2741. [PMID: 33864117 DOI: 10.1007/s00266-021-02273-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND In the surgical correction of tuberous breast deformity, implants and regional flaps play a prominent role. Lately, fat grafting has been used as an alternative, but there is evidence that patient satisfaction is higher after correction with implants compared with lipofilling. METHODS We report a tuberous breasts correction series of ten cases, enrolled between 2015 and 2018. Percutaneous fasciotomies and fat grafting were performed by the Body-Jet technique. Analysis of outcomes was undertaken with BREAST-Q surveys. RESULTS The breast satisfaction scores increased from 0 to 75 (p < 0.01), the psychological well-being scores from 20 to 70 (p < 0.01) and the sexual well-being scores from 18.5 to 58 (p = 0.02), while the physical well-being scores remained stable (from 68 to 63, p = 0.2). The median outcome satisfaction score was 86. CONCLUSION Scores of patient-reported outcomes after lipofilling can reach and even exceed those of patients corrected with implants, at the cost of more interventions. Fat grafting is beginning to establish itself as a true alternative in the treatment of tuberous breast deformity in patients with the appropriate fat deposits. 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 online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sarantos Papadopoulos
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Munckelstrasse 27, 45879, Gelsenkirchen, Germany.
- Private Practice, Vasillisis Olgas 158, 54645, Thessaloniki, Greece.
| | | | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Meletios P Nigdelis
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigorios F Grimbizis
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Joke Tio
- Department of Obstetrics and Gynecology, Breast Center, Muenster University, Muenster, Germany
| | - Abdallah Abdallah
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Munckelstrasse 27, 45879, Gelsenkirchen, Germany
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11
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Faure A, Mosca MV, Régas I, Pluvy I. [Tuberous breast deformity correction: Long-term satisfaction assessment with BREAST-Q questionnaire]. ANN CHIR PLAST ESTH 2021; 66:466-475. [PMID: 34563409 DOI: 10.1016/j.anplas.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tuberous Breast Deformity (TBD) is a complex breast malformation: shape, size and symmetry of breast can be affected. It causes physical and mental suffering with significant effect on life quality. The purpose of this study is to assess patients satisfaction and patients quality of life after TBD surgery over time. METHODS All TBD patients operated between January 2007 and December 2018 were retrospectively identified for the study and those treated whith implant and/or mammoplasty were included. Different parameters have been recorded: age, malformation severity, breast symmetry, BMI, pregnancies, breast-feeding, type of primary surgery, complications and number of re-operations. Long-term satisfaction was assessed thanks to a BREAST-Q questionnaire (with a special « augmentation » or « reduction/mastopexy » module according to the primary surgery). RESULTS Eighty-two patients were included: 35 patients had recieved bilateral breast implants, 14 patients had received unilateral breast implant with or without collateral mammoplasty, and 33 patients had undergone breast reduction surgery. The total average for the medical follow-up was 7.4 years. The number of intervention was significantly higher for patients who had undergone breast augmentation surgery (P=0.001) and for patients with severe TBD (P=0.01). Forty patients replied to the BREAST-Q questionnaire. Patients satisfaction scores were not significantly different between the different groups. Regarding life quality scores, patients undergoing a breast augmentation surgery with bilateral implants seemed to have a better "sexual well-being" score (P=0.03). "Physical well-being" score was lower for patients who had a breast reduction compared to the other groups (P=0.01). Patients with breast implants had significant better quality of life scores, especially for the following parameters: "psychosocial well-being" (P=0.02), "sexual well-being" (P<0.001), "physical well-being" (P<0.001) and "satisfaction with breast" (P=0.03). CONCLUSIONS TBD surgery basically provides long-term satisfaction for most of the patients. The number of re-operations does not seem to deteriorate satisfaction over time.
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Affiliation(s)
- A Faure
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de Besançon, 25000 Besançon, France.
| | - M V Mosca
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de Besançon, 25000 Besançon, France
| | - I Régas
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de Besançon, 25000 Besançon, France
| | - I Pluvy
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de Besançon, 25000 Besançon, France
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Papadopoulos S, Colpaert SDM, Goulis DG, Nigdelis MP, Grimbizis GF, Tio J, Abdallah A. Invited Response on: "Treating Anisomastia and Tuberous Breast with Fat Grafting: Technique and Evaluation of Outcomes Using BREAST-Q Surveys". Aesthetic Plast Surg 2021; 46:20-21. [PMID: 34342704 DOI: 10.1007/s00266-021-02503-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Sarantos Papadopoulos
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Munckelstrasse 27, 45879, Gelsenkirchen, Germany.
- Private Practice in Senology, Vasillisis Olgas 158, 54645, Thessaloniki, Greece.
| | | | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Meletios P Nigdelis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Grigorios F Grimbizis
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Joke Tio
- Department of Obstetrics and Gynecology, Breast Center, Muenster University, Muenster, Germany
| | - Abdallah Abdallah
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Gelsenkirchen, Germany
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13
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Breast Silicone Gel Implants versus Autologous Fat Grafting: Biomaterials and Bioactive Materials in Comparison. J Clin Med 2021; 10:jcm10153310. [PMID: 34362094 PMCID: PMC8348805 DOI: 10.3390/jcm10153310] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 12/11/2022] Open
Abstract
In the last 20 years, surgical procedures in breast remodeling during mammoplasty have been deeply modified with a gradual shifting from an invasive intervention using definitive implants (DIs) to a more conservative autologous fat grafting (AFG). AFG has been used for many years as bioactive material through the Lipofilling technique and as a bioactive scaffold when it was enriched with adipose-derived stem cells (ASCs), while DIs have been considered physiologically inert biomaterials with low toxicity. The paper aimed to compare the breast remodeling results obtained in the DI group (55 patients) for hypoplasia correction with those of the ASC-enhanced AFG group (50 patients), also analyzing the influence of breast and chest deformities (tuberous breast, volume, and nipple–areola complex asymmetry, pectus excavatum and carinatum) in the cosmetic outcome. A retrospective, case-control study was conducted. The pre-operative analysis was performed with an accurate clinical evaluation, a photographic assessment, and an instrumental evaluation based on magnetic resonance imaging, mammography, and ultrasound. Of patients treated with DIs 89% (n = 49) showed excellent cosmetic results after 1 year compared with the patients treated with AFG, who showed the same results in 64% (n = 32) of cases. The naturalness of the results in the AFG group was higher than that in the DI group (p < 0.0001 vs. DI group). DIs and AFG were safe and effective in this case series treated. The AFG group showed more natural results, allowing the treatment of patients with pectus excavatum, while DIs showed the more evident and lasting result.
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14
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Liu Y, Luan J. Treating Anisomastia and Tuberous Breast with Fat Grafting: Technique and Evaluation of Outcomes Using BREAST-Q Surveys. Aesthetic Plast Surg 2021; 46:18-19. [PMID: 34286381 DOI: 10.1007/s00266-021-02466-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
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15
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di Summa PG, Osinga R, Sapino G, Glen K, Higgins G, Tay S, Weiler-Mithoff E. Fat grafting versus implant-based treatment of breast asymmetry, a single surgeon experience over 13 years: a paradigm shift? Gland Surg 2021; 10:1920-1930. [PMID: 34268076 DOI: 10.21037/gs-21-91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/26/2021] [Indexed: 11/06/2022]
Abstract
Background Breast asymmetry can result from congenital or traumatic aetiologies. Breast implants, autologous fat grafting, or a combination of both of these techniques are commonly used to achieve symmetry. This study adds critical evaluation of long-term patient outcomes in a large study group, to evaluate pearls and pitfalls of these treatment modalities. Methods A prospectively maintained database of a single surgeon experience in breast asymmetry treatment over a 13-year period (2006-2018) was retrospectively analysed. Breast implant surgery and fat grafting to treat asymmetry were compared in terms of number of operations to achieve symmetry, complications, and overall patient satisfaction. Results Thirty-five patients underwent breast implant surgery, requiring an average 2.1±1.6 operations to achieve symmetry, with a major complication rate (requiring secondary procedures) of 26% (n=9). Again, 26% (n=9) were converted to lipofilling due to either implant removal or unsatisfactory results. Thirty (86%) patients underwent fat transfer monotherapy to achieve symmetry and no major complications were recorded. Nine percent (n=3) of these patients preceded to have additional implant surgery. Conclusions Although implant-based reconstruction seemingly offers a quick single stage procedure, it is associated with significantly more revision procedures as a result of complications including capsular contracture, implant rupture and breast distortion. Fat grafting, despite requiring sequential operations to achieve initial symmetry, ultimately offers a more durable result and is associated with significantly fewer and more minor complications, while not increasing the total number of procedures required to achieve symmetry in the long term.
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Affiliation(s)
- Pietro G di Summa
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK.,Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Rik Osinga
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK.,Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Gianluca Sapino
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Katie Glen
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Gillian Higgins
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Sherylin Tay
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK
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16
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Wu Y, Hu F, Li X, Yin G. Autologous Fat Transplantation for Aesthetic Breast Augmentation: A Systematic Review and Meta-Analysis. Aesthet Surg J 2021; 41:NP402-NP429. [PMID: 33655292 DOI: 10.1093/asj/sjaa364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Autologous fat transplantation has already become a part of clinical practice for aesthetic breast augmentation even though evidence regarding its efficacy is still lacking. OBJECTIVES The authors sought to determine the current worldwide status and efficacy, techniques, and oncologic safety on this subject. METHODS PubMed, EMBASE, and Cochrane Library databases were searched to identify all relevant studies. RESULTS Eighty-four articles published between 1987 and April 2020, consisting of 6468 patients, were included, and 64 studies consisting of 5162 unique patients were included in the meta-analysis. Most studies had a low level of evidence (levels 2b-5); In this meta-analysis, there were 17 prospective cohort studies, 4 retrospective cohort studies, 6 case-control studies, and 38 case series. The publications were from 21 countries. Indications for autologous fat transplantation were aesthetic augmentation (93.2%) and congenital malformation (6.8%). Among the 5162 patients, 2 cases (0.04%) of cancer were reported. The meta-analysis revealed very high overall patient and surgeon satisfaction rates of 93% and 87%, respectively. Overall, only 1.56 sessions were needed to achieve the desired result. Long-term survival was calculated to be approximately 60% to 70% at 1-year follow-up. Only 8% of procedures resulted in clinical complications, and 5% of patients required biopsy because of abnormal clinical or radiological findings. CONCLUSIONS Autologous fat transplantation seems to be a major tool in aesthetic breast augmentation. Preoperative patient selection is essential but under-reported. Future research should focus on evaluating the technical and patient factors influencing the rate of fat survival and its oncological safety. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Yingjie Wu
- Department of Plastic and Aesthetic Surgery, Guangxi Medical University First Affiliated Hospital, Nanning City, Guangxi, China
| | - Feng Hu
- Department of Orthopaedics, Guangxi Medical University Second Affiliated Hospital, Nanning City, Guangxi, China
| | | | - Guoqian Yin
- Department of Plastic and Aesthetic Surgery, Guangxi Medical University First Affiliated Hospital, Guangxi Medical University, Nanning City, Guangxi, China
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17
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Quality of life after autologous fat transfer additional to prosthetic breast reconstruction in women after breast surgery: A systematic review. Eur J Surg Oncol 2020; 47:772-777. [PMID: 33243607 DOI: 10.1016/j.ejso.2020.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Breast cancer is the most frequent form of cancer among women worldwide. Reconstructive surgery may improve the quality of life (QoL), after mastectomy. Various techniques are used to reconstruct the female breast; however, few is known about its specific post-surgery influence represented in patient-reported outcomes. OBJECTIVE This systematic review assesses the difference in patient-reported QoL between prosthetic reconstruction alone, and prosthetic reconstruction with additional autologous fat transfer (AFT). DATA SOURCES A literature search was performed in PubMed, Embase, Cochrane and CINAHL online databases from inception to February 11th, 2020. STUDY SELECTION Inclusion and exclusion criteria were used to assess the eligibility of the retrieved articles. The only eligible studies were cohort studies. DATA COLLECTION AND ANALYSIS Relevant data for the research question was extracted from the articles and systematically documented. Results not contributing to answering the objective were intentionally left out. No meta-analysis was realized. RESULTS This systematic review resulted in the inclusion of only six relevant studies, all cohort studies, consisting of 1437 unique patients. These studies evaluated the quality of life of patients by means of the validated BREAST-Q questionnaire. Outcomes varied for which reason no definite answer could be provided to whether additional AFT results in a higher QoL. CONCLUSIONS It is unclear whether additional AFT after prosthetic surgery leads to a higher QoL when compared to sole prosthetic reconstruction or not. Additional studies, assessing the QoL of patients who received additional AFT, are required to draw solid conclusions. LEVEL OF EVIDENCE Level III; systematic literature review of cohort studies.
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18
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Gutierrez-Ontalvilla P, Naidu NS, Blanco EL, Brito EC, Ruiz-Valls A. Autologous Fat Grafting with Percutaneous Fasciotomy and Reduction of the Nipple-Areolar Complex for the Correction of Tuberous Breast Deformity in Teenagers. Aesthetic Plast Surg 2020; 44:264-269. [PMID: 31673737 DOI: 10.1007/s00266-019-01531-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tuberous breast deformity in the adolescent can be a source of anxiety and social isolation. Current techniques of implant placement and flap reconstruction are not always feasible in this population. OBJECTIVES The authors evaluated the use of autologous fat grafting with percutaneous fasciotomy and reduction in the nipple-areolar complex for correction of tuberous breast deformity in teenagers. METHODS A retrospective chart review was conducted for nine teenaged patients with tuberous breast deformity who received autologous fat grafting between January 2016 and December 2018. The recipient site was prepared with the use of percutaneous fasciotomies to release the constricted lower pole of the breast, lowering of the inframammary crease, and reduction in the nipple-areolar complex. Fat was harvested by conventional liposuction prior to injection through three designated sites located at the inframammary fold, anterior axillary line, and upper pole. Complications were recorded. RESULTS Patients had an average age of 14.9 years at the time of surgery. An average of 1.8 filling sessions were required with a mean of 220 cc of fat injected per breast. Patients were followed for an average of 21 months postoperatively. No serious complications were noted. All patients reported satisfaction with their final outcomes. CONCLUSIONS Autologous fat grafting in conjunction with percutaneous fasciotomy and reduction in the nipple-areolar complex is a safe and effective treatment of the tuberous breast deformity in teenage patients. It provides an esthetic result with minimal scarring and high satisfaction rates while eliminating the need for flaps or implants. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Patricia Gutierrez-Ontalvilla
- Department of Plastic and Reconstructive Surgery, Functional Unit of Plastic Pediatric, La Fe University Hospital, Valencia, Spain
| | - Nina S Naidu
- , New York, USA.
- Weill Cornell Medical Center, New York, NY, 10065, USA.
| | - Eva Lopez Blanco
- Department of Plastic and Reconstructive Surgery, Functional Unit of Plastic Pediatric, La Fe University Hospital, Valencia, Spain
| | - Eloy Condiño Brito
- Department of Plastic and Reconstructive Surgery, La Fe University Hospital, Valencia, Spain
| | - Alejandro Ruiz-Valls
- Department of Plastic and Reconstructive Surgery, La Fe University Hospital, Valencia, Spain
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19
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Rigotti G, Chirumbolo S. Biological Morphogenetic Surgery: A Minimally Invasive Procedure to Address Different Biological Mechanisms. Aesthet Surg J 2019; 39:745-755. [PMID: 30137183 DOI: 10.1093/asj/sjy198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We present a methodology called biological morphogenetic surgery (BMS) that can recover (enlarge or reduce) the shape/volume of anatomic structures/tissues affected by congenital or acquired malformations based on a minimally invasive procedure. This emerges as a new concept in which the main task of surgery is the biological modulation of different remodeling and repair mechanisms. When applied, for example, to a tuberous breast deformity, the "enlarging BMS" expands the retracted tissue surrounding the gland through a cutting tip of a needle being inserted through small incisions percutaneously, accounting for the biological activity of the grafted fat. The obtained spaces might be spontaneously occupied and later filled with autologous grafted fat, which promotes tissue expansion by eliciting adipogenesis and preventing fibrosis. The "reducing BMS" creates an interruption of the contact between the derma and the hypoderma of the abnormally large areola and then promotes adipocytes to induce a fibrotic reaction, leading to areola reduction. Current evidence suggests that BMS might induce a bivalent mesenchymalization of the adipocyte, which promotes either new adipogenesis and angiogenesis of local fat (expanding BMS) or the granulation tissue/fibrotic response (reducing BMS), thus leading to the physiological recovery of the affected structures/tissues to normality. Level of Evidence: 4.
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Affiliation(s)
- Gino Rigotti
- Unit Head of Reconstructive Breast and Plastic Surgery, Clinica San Francesco, Verona, Italy
| | - Salvatore Chirumbolo
- Department of Neuroscience, Biomedicine and Movement Sciences-University of Verona, Verona, Italy
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20
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Tuberous Breast Deformity Correction: 12-year Experience. Aesthetic Plast Surg 2019; 43:16-26. [PMID: 30411146 DOI: 10.1007/s00266-018-1261-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/21/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND This article shows our 12-year experience in application of the technique of breast parenchyma modification with simultaneous augmentation on the tuberous breast. We undertook the study, and with the results of this study we can say that tuberous breast deformation is a common pathology that is caused not only by a thickening of the superficial fascia but also by breast parenchyma fibrosis. When traditional techniques without parenchyma modification are used during the surgery, it is often that patients come back to treat complications. METHODS A total of 208 patients (414 breasts) with tuberous breast deformation treated from 2005 to 2017 were included. The mean patient age was 31 years (range, 22-53 years). A periareolar approach, vertical and horizontal glandular scoring, dual-plane pocket creation, and anatomic implants were used in all cases. RESULTS The mean follow-up was 36 months (range, 3-144 months). Deformities of the types I-IV by Von Heimburg were corrected. The global complication rate for all patients in this study was 8.9%-1.4% had capsular contracture, 1.5% had postoperative malposition, 2% had "double bubble" , 2% had rippling, 2% had areola and nipple sensitivity disorder. CONCLUSION The authors' experience demonstrates that the described one-stage approach combining mammary gland parenchyma modification (glandular scoring) with dual-plane pocket and anatomic implants provides satisfactory results for treatment of tubular breast deformity with minimal complications and other effects that require repeated treatment. 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 .
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21
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Krastev TK, Alshaikh GA, Hommes J, Piatkowski A, van der Hulst RR. Efficacy of autologous fat transfer for the correction of contour deformities in the breast: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2018; 71:1392-1409. [DOI: 10.1016/j.bjps.2018.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 05/09/2018] [Accepted: 05/27/2018] [Indexed: 12/16/2022]
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22
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Groen JW, Piatkowski AA, Sawor JH, Wilschut JA, Khouri RK, van der Hulst RRJW, Ritt MJPF. Autologous Fat Transfer After Augmentation and Reconstruction of the Female Breast: An International, Cross-Sectional Photo-Comparison Study Among Different Physician and Laymen Study Groups. Surg Innov 2018; 25:594-601. [PMID: 30196770 PMCID: PMC6293439 DOI: 10.1177/1553350618798435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective. The aim of this study is to compare the cosmetic
evaluation of autologous fat transfer (AFT) for various indications between
surgeons and different laymen groups. Background Data. Despite
the upsurge in AFT scientific/clinical interest, objectifying satisfaction has
only recently progressed beyond simple Likert-type/Visual Analog Scales.
Furthermore, differences in satisfaction between laymen and surgeons has not
been thoroughly studied. Method. A photo comparison study
between European plastic surgeons and different laymen groups was conducted to
investigate agreement on cosmetic evaluation of AFT. Three sets of
preoperative/postoperative photographs illustrating patients treated with
External Vacuum Expansion (EVE) + AFT for various indications in breast surgery
were scored according to the Harris Scale, and the interrater agreement was
analyzed using Cohen’s κ. Results. The overall agreement
between the surgeons and the groups of former augmentation, control group, and
deep inferior epigastric artery perforator patients was fair, moderate, and
substantial, respectively. Interrater agreements among different laymen groups
and surgeons from different countries among themselves was substantial to almost
perfect. Finally, we found that laymen are generally more optimistic about
postoperative results than surgeons. Conclusion. In our study,
former augmentation patients showed the lowest agreement with surgeons, in the
cosmetic appreciation of EVE + AFT and this group might benefit from a more
thorough preoperative consultation regarding expectations when choosing AFT.
However, overall laymen tend to be more optimistic about postoperative results
and surgeon education in general does not seem influenced by surgeon
nationality. The significant differences between surgeons and laymen in the
cosmetic evaluation of EVE + AFT justifies further studies that focus on the
qualitative aspects of these differences to further balance patients’ and
surgeons’ expectations.
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Affiliation(s)
- Jan-Willem Groen
- 1 Department of Plastic, Reconstructive and Hand Surgery/ GROW: School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands.,2 Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, Netherlands
| | - Andrzej A Piatkowski
- 1 Department of Plastic, Reconstructive and Hand Surgery/ GROW: School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands.,3 Department of Plastic, Reconstructive and Hand Surgery, Viecuri Medical Center, Venlo, The Netherlands
| | - John H Sawor
- 1 Department of Plastic, Reconstructive and Hand Surgery/ GROW: School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands.,3 Department of Plastic, Reconstructive and Hand Surgery, Viecuri Medical Center, Venlo, The Netherlands
| | | | - Roger K Khouri
- 5 Miami Breast Center, Key Biscayne, Florida, United States
| | - Rene R J W van der Hulst
- 1 Department of Plastic, Reconstructive and Hand Surgery/ GROW: School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Marco J P F Ritt
- 2 Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, Netherlands
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