Abstract
Background
Treatment of tuberous breasts types 1 and 2 must deal with the problem of the pseudo-double bubble in the primitive inframammary fold and also must release the constrictive ring. Two techniques currently are used to overcome these problems, but neither is entirely satisfactory. The first technique, in which the approach is via the primitive inframammary fold, leaves significant scarring when the lower poles expand. The second technique, in which the approach is periareolar, considerably reduces the area’s sensitivity. This report presents a new endoscopically assisted technique with an axillary approach designed to solve these problems.
Methods
Between 2005 and 2010, 68 patients (ages 18–42 years) underwent surgery. The intervention was bilateral in 57 and unilateral in 11 of these patients. All cases involved tuberous breasts types 1 and 2 (Grolleau’s classification). The augmentation involves a transaxillary subfascial endoscopic approach, opening of the fascia at the primitive inframammary fold, and releasing of the constricting ring to enable the breast to expand, followed by implantation of an anatomic prosthesis to add volume to the lower quadrants. If the pseudo-double bubble appears, fat grafting is applied during the same surgical procedure.
Results
The results were reported to be highly satisfactory both by the patients and by the independent medical team. For six patients (8.82 %), fat grafting had to be repeated in the double bubble. No major complications were reported.
Conclusion
The endoscopically assisted subfascial breast augmentation technique obtains highly satisfactory results in tuberous breasts types 1 and 2 (Grolleau’s classification). The single scar is concealed in the axillary fold.
Level of Evidence IV
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References
Aston SS, Rees TD (1980) Mammary augmentation, correction of asymmetry, and gynecomastia. In: Rees TD (ed) Aesthetic plastic surgery. Saunders, Philadelphia, pp 990–995
Bass CB (1978) Herniated areola complex. Ann Plast Surg 1:402–406
Coleman SR, Mazzola RF (2009) Fat injection from filling to regeneration. Quality Medical Publishing, Inc, St. Louis, MO
Grolleau JL, Lanfrey E, Lavigne B, Chavoin JP, Costagliola M (1999) Breast base anomalies: treatment strategy for tuberous breasts, minor deformities, and asymmetry. Plast Reconstr Surg 104:2040
Kolker AR, Austen WG Jr, Slavin SA (2010) Endoscopic-assisted transaxillary breast augmentation: minimizing complications and maximizing results with improvements in patient selection and technique. Ann Plast Surg 64:667–673
Mandrekas AD, Zambacos GJ, Anastasopoulos A, Hapsas D, Lambrinaki N, Ioannidou-Mouzaka L (2003) Aesthetic reconstruction of the tuberous breast deformity. Plast Reconstr Surg 112:1099–1108
Muti E (2010) Tuberous Breast. SEE Editrice, Firenze, pp 43–57
Puckett Cl, Concannoud MJ (1990) Augmenting the narrow based breast: The unfurling techniques to prevent the double-bubble deformity. Aesthet Plast Surg 14:15–19
Rees TD, Aston SJ (1976) The tuberous breast. Clin Plast Surg 3(2):339–347
Ribeiro L, Canzi W, Bass A, Accorsi AJ (1998) Tuberous breast: a new approach. Plast Reconstr Surg 101:42
Serra-Renom JM (1997) Retractor with mobile endoscope. Plast Reconstr Surg 100:529
Serra-Renom J, Garrido MF, Yoon T (2005) Augmentation mammaplasty with anatomic soft, cohesive silicone implant using the transaxillary approach at a subfascial level with endoscopic assistance. Plast Reconstr Surg 116:640–645
Serra-Renom JM, Muñoz-Olmo JL, Serra-Mestre JM (2010) Fat grafting in postmastectomy breast reconstruction with expanders and prostheses in patients who have received radiotherapy: formation of new subcutaneous tissue. Plast Reconstr Surg 125:12–18
Serra-Renom JM, Muñoz-Olmo JL, Serra-Mestre JM (2011) Breast reconstruction with fat grafting alone. Ann Plast Surg 66:598–601
Serra-Renom JM, Muñoz-Olmo JL, Serra-Mestre JM (2011) Treatment of tuberous breasts grade III with Puckett’s technique (modified) and fat grafting to correct the constricting ring. Aesthet Plast Surg 35(5): 773–781
Teimourian B, Menhdi N (1983) Surgical correction of the tuberous breasts. Ann Plast Surg 10:190–193
Toranto R (1981) Two-stage correction of tuberous breast. Plast Reconstr Surg 67:642–645
Williams G, Hoffman S (1981) Mammoplasty for tubular breast. Aesthet Plast Surg 5:51–56
Versaci AD, Rozzelle AA (1991) Treatment of tuberous breast utilizing tissue expansion. Aesthet Plast Surg 15:307–312
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Serra-Renom, J.M., Muñoz-Olmo, J. & Serra-Mestre, J.M. Endoscopically Assisted Aesthetic Augmentation of Tuberous Breasts and Fat Grafting to Correct the Double Bubble. Aesth Plast Surg 36, 1114–1119 (2012). https://doi.org/10.1007/s00266-012-9921-2
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DOI: https://doi.org/10.1007/s00266-012-9921-2