Management of Congenital Melanocytic Naevus (CMN) of the Lower Pole of the Breast Causing Secondary Tuberous Breast Deformity (TBD)- A Case Report and Review of Literature: Congenital Melanocytic Naevus &Tuberous Breast Deformity

Abstract

A 19-year-old woman was referred with a congenital melanocytic naevus (CMN) involving the lower pole of her right breast, combined with features of tuberous breast deformity (TBD) and breast asymmetry. Staged correction of the breast asymmetry was planned. The first stage involved recruitment of her right upper abdominal skin, in a reverse abdominoplasty manner, to address the lower pole skin deficiency. Extensive radial release of the constriction bands across the original IMF (inframammary fold), and circum-areolar mastopexy were performed. A sub-glandular breast implant was inserted. Four weeks later, she presented with minor inframammary wound breakdown. Washout and removal of the implant, combined with breast parenchymal tissue rearrangement was performed. We performed her planned second stage 3 months later in the form of; a right vertical pattern mastopexy, lipofilling and revision of the reverse abdominoplasty to adjust the nipple and IMF position. The remaining CMN was excised and resurfaced with a full thickness skin graft from the contralateral mastopexy. The leathery quality of CMN makes the achievement of correcting the breast deformity impossible without its excision. This combination of CMN and TBD makes management of these cases more challenging than manging each on its own. To the best of our knowledge, this is the first case report of the effect of moderate CMN on the breast and its development.