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Casanova D, Eraud J, Philandrianos C, Bertrand B, Abellan Lopez M. [Classification of mammary asymmetries and principles of treatment]. ANN CHIR PLAST ESTH 2022; 67:335-357. [PMID: 36075798 DOI: 10.1016/j.anplas.2022.07.021] [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: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 11/18/2022]
Abstract
Constitutional breast asymmetries are responsible not only for esthetic unsightliness, but also, at times, for psychological disorders, and medical management is necessitated. While surgical treatment is the only viable therapeutic option, given the wide variety of morphological presentations of mammary asymmetries, the surgeon is called upon to be well versed in breast surgery techniques. The authors have put forward a classification of mammary asymmetries and principles of treatment.
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Affiliation(s)
- D Casanova
- Service de chirurgie plastique et réparatrice, hôpital de la Conception, Marseille, France.
| | - J Eraud
- Service de chirurgie plastique et réparatrice, hôpital de la Conception, Marseille, France
| | - C Philandrianos
- Service de chirurgie plastique et réparatrice, hôpital de la Conception, Marseille, France
| | - B Bertrand
- Service de chirurgie plastique et réparatrice, hôpital de la Conception, Marseille, France
| | - M Abellan Lopez
- Service de chirurgie plastique et réparatrice, hôpital de la Conception, Marseille, France
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Duquennoy-Martinot V, Calibre C, Guerreschi P, Belkhou A, Barry L. [Is it legitimate to propose surgery of the breast area before the end of puberty?]. ANN CHIR PLAST ESTH 2022; 67:425-437. [PMID: 35879119 DOI: 10.1016/j.anplas.2022.06.007] [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: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 11/01/2022]
Abstract
Breast surgery is usually recommended for women who have completed puberty. Indeed, during adolescence the breast is constantly changing, the patient's weight is often unstable, the risk of inflammatory scars (hypertrophic or keloid) is higher and disturbances of areolar sensitivity can affect the patient's quality of sexual life. In addition, the risk of infection is not negligible, especially during an acne outbreak. In case of early implant placement, iterative changes should be planned. Finally, the result obtained is not always stable but above all the lack of psychological maturity and the legal need to obtain the agreement of both parents are obstacles to early surgery. However, the authors argue for the possibility of surgical correction of the breast around puberty, in particular because of the very clear positive psychological impact. Other arguments are also detailed: to ensure a breast reconstruction in successive stages started early, to limit the repercussions of hypertrophy, to correct thoracic or skin anomalies. These indications are illustrated by numerous clinical cases demonstrating the need for customized surgery on a case-by-case basis.
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Affiliation(s)
- V Duquennoy-Martinot
- Service de chirurgie plastique et réparatrice, hôpital Salengro, 59037 Lille Cedex, France.
| | - C Calibre
- Service de chirurgie plastique et réparatrice, hôpital Salengro, 59037 Lille Cedex, France.
| | - P Guerreschi
- Service de chirurgie plastique et réparatrice, hôpital Salengro, 59037 Lille Cedex, France.
| | - A Belkhou
- Service de chirurgie plastique et réparatrice, hôpital Salengro, 59037 Lille Cedex, France.
| | - L Barry
- Service de chirurgie plastique et réparatrice, hôpital Salengro, 59037 Lille Cedex, France.
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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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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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Brault N, Stivala A, Guillier D, Moris V, Revol M, François C, Cristofari S. Correction of tuberous breast deformity: A retrospective study comparing lipofilling versus breast implant augmentation. J Plast Reconstr Aesthet Surg 2017; 70:585-595. [PMID: 28341593 DOI: 10.1016/j.bjps.2017.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
Abstract
Breast implants and, more recently, autologous fat grafting are the two most common treatments used to correct tuberous breast deformity (TBD). The post-surgical quality of life between the two techniques is not well demonstrated. This study aimed to compare satisfaction and health-related quality of life in patients affected by TBD between these two techniques. All TBD patients operated between January 2008 and May 2015 were retrospectively identified, and only those treated with implants or lipofilling were included. Satisfaction was evaluated at least 6 months after surgery with the postoperative Breast-Q® augmentation module. From January 2008 to May 2015, 62 patients were recruited in our study, and 37 patients were evaluated using a Breast-Q questionnaire after at least 6 months of follow-up. Breast implant-augmented patients were significantly more satisfied concerning the "satisfaction with breasts" module (p = 0.002) and the "satisfaction with outcome" module (p = 0.00008). A question-by-question analysis revealed several interesting and significant differences, showing higher scores in most of the questions in the breast implant group. Patients in the lipofilling group, interestingly, had a mean of 1.6 interventions compared to the mean 1.36 interventions in the implant group (p = 0.23). This reflects the need to perform more surgical sessions in the lipofilling group to achieve a satisfactory result. Our study demonstrated that tuberous breast correction with implants can achieve better satisfaction along with good outcomes than lipofilling usually does.
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Affiliation(s)
- Nicolas Brault
- Department of Plastic, Reconstructive and Aesthetic Surgery, Saint Louis Hospital, AP-HP Hôpital Saint-Louis, Avenue Claude Vellefaux, 75475, Paris Cedex 10, France; Paris Diderot University, Sorbonne Paris, France
| | - Alessio Stivala
- Department of Plastic, Reconstructive and Aesthetic Surgery, Saint Louis Hospital, AP-HP Hôpital Saint-Louis, Avenue Claude Vellefaux, 75475, Paris Cedex 10, France; Paris Diderot University, Sorbonne Paris, France.
| | - David Guillier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Saint Louis Hospital, AP-HP Hôpital Saint-Louis, Avenue Claude Vellefaux, 75475, Paris Cedex 10, France; Paris Diderot University, Sorbonne Paris, France; Plastic and Reconstructive Surgery, 14 rue Paul Gaffarel, 21079, Dijon, France
| | - Vivien Moris
- Department of Plastic, Reconstructive and Aesthetic Surgery, Saint Louis Hospital, AP-HP Hôpital Saint-Louis, Avenue Claude Vellefaux, 75475, Paris Cedex 10, France; Paris Diderot University, Sorbonne Paris, France; Plastic and Reconstructive Surgery, 14 rue Paul Gaffarel, 21079, Dijon, France
| | - Marc Revol
- Department of Plastic, Reconstructive and Aesthetic Surgery, Saint Louis Hospital, AP-HP Hôpital Saint-Louis, Avenue Claude Vellefaux, 75475, Paris Cedex 10, France; Paris Diderot University, Sorbonne Paris, France
| | - Caroline François
- Department of Plastic, Reconstructive and Aesthetic Surgery, Saint Louis Hospital, AP-HP Hôpital Saint-Louis, Avenue Claude Vellefaux, 75475, Paris Cedex 10, France; Paris Diderot University, Sorbonne Paris, France
| | - Sarra Cristofari
- Department of Plastic, Reconstructive and Aesthetic Surgery, Saint Louis Hospital, AP-HP Hôpital Saint-Louis, Avenue Claude Vellefaux, 75475, Paris Cedex 10, France; Paris Diderot University, Sorbonne Paris, France
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