Aesthetic Reconstruction of the Tuberous Breast Deformity: A 10-Year Experience

Abstract

Tuberous breast deformity is a developmental aberration of the breast whereby a constricting ring on the base of the breast prevents its expansion on the horizontal and/or the vertical axis. This leads to the well-known "tuberous" appearance of the breast, causing a herniation of the breast tissue toward the nipple-areola complex due to the increased pressure. Several techniques have been proposed to correct this deformity, but the aesthetic results have generally been poor. The authors present their theory on the etiology of the deformity, which has been further substantiated by their histological series of patient findings over the course of 10 years. They also present their technique and experience in treating 22 patients (41 breasts) over the past 10 years. Twenty-two women (41 breasts) with tuberous breast deformity were treated in the authors' private clinic over the past 10 years. Treatment protocol included a periareolar incision followed by a reconstruction of the breast tissue through transection of the constricting ring and formation of two breast pillars, which were folded toward one another to provide the missing volume on the inferior part of the breast. A silicone breast implant could also be placed subglandularly or submuscularly for additional volume. The oversized nipple areola complex was addressed via a donut-type periareolar excision. Bruising and swelling commonly resulted from application of this technique, but this is a predictable postoperative symptom. In terms of complications, there was one case of hematoma on the right breast of a bilateral reconstruction, which had to be evacuated. No patients had skin necrosis or loss of nipple sensation. The same patient who developed a hematoma developed a Baker III case of capsular contracture in the same breast. One patient developed asymmetry but refused revision. All scars were confined to the periareolar margin and were virtually invisible. The authors propose a technique that is simple and yields consistently good results for the treatment of tuberous breast deformity. This technique has the added advantage of not disturbing the lactiferous ducts, thus preserving normal breast function. Patients who have been treated by the authors with this method over the past 10 years have experienced good postoperative results with few complications, and it provides a strong alternative to the existing but varied techniques for addressing the deformity.