Reconstructive breast surgery
Tuberous breasts are a congenital malformation of the breasts
This malformation of the breast, of unknown origin, appears at puberty. Disfigurement is variable depending on the severity of the disease, ranging from frequently undetectable forms (types 1 and 2) to severe forms (type 3) with major disfigurement
The function of the breast is preserved allowing the patient to breastfeed. The tuberous breast is defined by various forms of anomalies :
- an abnormally narrow breast base at the chest wall with the fold under the breast sitting too high. This gives the impression that the breast is sagging however it is because the breast fold is too high ;
- a long skin envelope gives the impression of a lack of skin ;
- a neck line often showing stretch marks ;
- an oversized areola in comparison to the size of the breast. Sometimes the areola protrudes (areolar protrusion) ;
- a breast that is often too small (but it may be of normal volume or too large ) ;
- an asymmetry between the two breasts is very common (70% of cases). Both breasts are usually tuberous but one of the two breasts may be more severely affected than the other.
Tuberous breast syndrome is considered rare affecting of 5 out of 10,000 women. However, the exact impact is unknown and difficult to determine due to a lack of diagnostics. Minor to moderate forms either do not motivate patients to consult because of their non-debilitating character or surgeons who are not experienced with the condition do not diagnose it.
The breast is the most visible part of the sexual organs and is the symbol of femininity for teenage girls : well developed, inadequate, balanced, weird ... These terms risk being attributed to the whole person during puberty. Even if it is impossible to define the perfect breast, any big differences from what is considered an "ideal" breast create a psychological and physical anxiety in adolescents. Poor body image can lead to a real psychosocial disability with self-exclusion from activities (sport, recreation), avoidance of medical examinations because of shame felt by having "ridiculously" shaped breasts, concealing breasts with unflattering clothes and an unfulfilling sexual life.
Surgical treatment of tuberous breast syndrome
Surgical treatment is a real challenge as there is a fine line between cosmeticand reconstructive surgery. All the techniques used in cosmetic and reconstructive breast surgery can be used and combined in order to best suit the patient (breast implants, breast lift with or without reduction, fat injections ...).
Because of the impact surgery can have on the body image, patients who require subtle changes should consider being operated on at the end of puberty. ?Two exceptions are possible :
- The presence of significant stretch marks can drive early intervention in order to preserve the quality of the skin ;
- Insertion of breast implants is a decision that should be taken into careful consideration because of the impact it can have on the future. Thus, it is best to wait until adulthood.
Preference is given to treatment performed in one procedure. Two surgical phases are required if:
- the decision to expand the skin with a temporary expansion implant has been made (very rarely) ;
- deformity is corrected without increasing volume from the end of puberty and an increase is desired in adulthood.
Several procedures are required when having only lipofilling (2-3 sessions usually spaced from 5 to 6 months apart). In all cases, the patient should be made aware of having potential touchups in the months following the initial surgery (enlargement of the areola, recurrence of the protrusion ...), usually under local anesthesia.
Health insurance coverage
For severe or moderate cases, partial reimbursement of the cost of the procedure may be considered upon prior agreement.
Author: Dr. Christophe Laveaux
Specialist in aesthetic surgery - Antibes
Reproductions, even partial, of the texts are allowed on the express condition cite the author (Dr. Christophe Laveaux) with a direct link to the article mentioned.