Disorders of the female breast in the pediatric age group

The Influence of Age on Complications After Correction of Congenital Breast Deformities: A National Analysis of the Pediatric and Adult NSQIP Data Sets

BACKGROUND

Timing of surgical intervention is controversial among patients seeking correction of congenital breast deformities.

OBJECTIVES

This study aimed to assess the influence of age on 30-day complications and unplanned healthcare utilization after reconstruction of congenital breast deformities.

METHODS

Female patients undergoing breast reconstruction for congenital breast deformities and Poland syndrome were identified on the basis of International Classification of Diseases (ICD) codes in the 2012 to 2021 pediatric and adult National Surgical Quality Improvement Project (NSQIP) data sets. Complications based on age at correction were compared, and multivariate logistic regression was used to identify predictors of overall and wound healing complications.

RESULTS

Among 528 patients meeting inclusion criteria, mean (SD) age at surgical correction was 30.2 (13.3) years. Patients most commonly underwent implant placement (50.5%), mastopexy (26.3%), or tissue expander placement (11.6%). Across the cohort, overall incidence of postoperative complications was 4.4%, most commonly superficial surgical site infection (1.0%), reoperation (1.1%), or readmission (1.0%). After multivariate adjustment, increasing age at time of correction was associated with higher incidence of wound complications [odds ratio (OR) 1.001; 95% confidence interval (CI) 1.0003-1.002; P = .009], in addition to BMI (OR 1.002; 95% CI 1.0007-1.004; P = .006) and tobacco use (OR 1.06; 95% CI 1.02-1.11; P = .003).

CONCLUSIONS

Breast reconstruction for congenital breast deformities may be safely undertaken at a young age with a low associated risk of postoperative complications. Large, multi-institutional studies are needed to assess the influence of surgical timing on psychosocial outcomes in this population.

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.

Hypoplastic breast anomalies in the female adolescent breast

Hypoplastic breast anomalies remain a reconstructive challenge. In this article, the authors review the spectrum of nonsyndromic breast hypoplasia in the adolescent girl, namely idiopathic breast hypoplasia and tuberous breast deformity. Challenges specific to this population include (1) identifying the ideal timing for surgery, (2) choosing the optimal reconstructive method while taking into consideration ongoing changes in the female body (e.g., future pregnancy), and (3) considering the use of a two-stage reconstructive approach to gradually expand the skin envelope. A comprehensive review of surgical techniques that address these conditions is provided, taking into account the evolution and the most recent advances in surgical techniques.

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.

Mammae erraticae: a case report and reappraisal of the related theories

Extra nipples and breast tissue outside the orthotopic location of the mammary glands are called polythelia and polymastia, respectively. Although the theory of mammary ridge remnants can explain extra breast tissue along the milk line, other locations such as the dorsum of the body still need further discussion. This report describes a 28-year-old Caucasian woman with a perfectly formed breast together with a meningocele in the lumbar region. Kyphoscoliosis and growth retardation were accompanying pathologies. As far as the authors can discern, this is the first case in the literature showing a well-formed breast and dysraphism occurring together.

LEVEL OF EVIDENCE V

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