Oncoplastic breast surgery to prevent "Bird's beak" deformity in the breast: a comparative retrospective study.

PURPOSES: Breast deformity occurring in the lower pole after breast conserving surgery (BCS) is known as bird's beak (BB) deformity. This retrospective study evaluated the outcomes in breasts reconstructed with a conventional closing procedure (CCP) and a downward-moving procedure (DMP), respectively, after BCS. METHODS: In CCP, the inferomedial and inferolateral portions of breast tissues were reapproximated toward the midline after wide excision to repair the breast defect. In DMP, the retro-areolar breast tissue was detached from the nipple-areolar complex after wide excision, and the upper pole breast tissue was moved downward to refill the breast defect. RESULTS: CCP was performed in 20 patients (Group A), and DMP was performed in 28 patients (Group B). Although retraction of the lower part of the breast was postoperatively observed in 13 (72%) of 18 patients from Group A, it was observed in 7 (28%) of 25 patients in Group B (p < 0.05). The downward pointing of the nipple was observed in 8 (44%) of 18 patients from Group A and in 4 (16%) of 25 patients in Group B (p < 0.05). CONCLUSIONS: DMP is more useful for preventing BB deformity than CCP.

Reply to Comment to: Tuberous Breast Associated with Chest Wall Deformity: A Challenging Planning for Breast Augmentation.

Even in cases of noticeable breasts asymmetry, such as in our case, it is advisable to use implants with the same volume and projection, in order to maintain a similar breast footprint and allow a similar aging behavior over time. This can be achieved by reducing the size of the larger breast, thereby addressing the volume discrepancy before the placement of the implants. However, in our case, the skeletal deformities resulted in a significant disparity in the projection of the right and left sides of the chest wall, hindering the use of breast implants with identical projection. Therefore, due to this asymmetrical chest wall deformity, the left prosthesis was placed behind the central and lateral glandular parenchyma, avoiding hyper-projection in the medial part of the breast.Level of Evidence V 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 .

Reply to: A Two-Step Approach for Breast Augmentation with Chest Wall Deformity?

Patients asking for cosmetic breast surgery often appreciate that their breasts have an unpleasing appearance, but they often do not have a full appreciation of the degree of potential anatomic abnormalities of the chest wall and of the specific anatomical characteristics, which require a meticulous surgical planning and techniques in comparison with a standard breast cosmetic surgery. Failure to recognize this will predispose the patient to an unsatisfactory outcome and secondary deformities. To maximize surgical predictability and patients' satisfaction, the authors proposed a two-stage approach in the scenario of patients presenting with chest wall deformities and asking for breast augmentation. However, as we contemplate adopting the authors' approach to our case, we anticipate encountering two primary challenges. Firstly, utilizing custom-made 3D silicone implants might exacerbate the projection of the chondrocostal prominence present in our patient. Indeed, we believe that these implants are more beneficial for addressing concave defects (such as pectus excavatum) rather than convex prominences, as observed in our case.Level of Evidence V 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 .

Correction of the Tuberous Breast with Fat Grafting and Implant: Techniques, Evaluation with BREAST-Q, and Preliminary Results.

BACKGROUND: The correction of tuberous breast deformity with fat grafting has gained popularity in recent years, but it remains unclear whether this new technique can produce patient satisfaction levels comparable to those achieved with implant-based correction. METHODS: This study aimed to compare patients' satisfaction and quality of life using the BREAST-Q questionnaire after correction of tuberous breast deformity with fat grafting and implants. Twenty-four patients (36 breasts) were included in our study. Thirteen patients (15 breasts) had a correction with lipofilling (mean 2.67 interventions) and 11 patients (21 breasts) had an implant-based correction (mean 1 intervention). RESULTS: Both fat and implant treatments showed statistically significant improvements in breast satisfaction (p value=0.001, 0.002, respectively), psychosocial (p value=0.003, 0.003, respectively), and sexual satisfaction (p value=0.008, 0.002, respectively) between the pre-treatment and post-treatment stages. However, the only statistically significant differences between the treatments were observed in the physical condition pre-treatment (p value=0.008) and sexual condition post-treatment (p value=0.030). The outcome of both treatments was not statistically different. Furthermore, the outcome exhibited a statistically significant positive linear relationship with breast satisfaction for both treatments. CONCLUSIONS: This study suggests that lipofilling can achieve breast and outcome satisfaction comparable to that of implants, although this parity in results comes at the cost of more interventions. These preliminary results lend support to the notion that, as surgeons have access to two equally effective techniques, it is crucial to provide appropriate guidance to patients to ensure their satisfaction. 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 .

Quantitative Analysis of the Histological Features of Tuberous Breast.

INTRODUCTION: Tuberous breast deformity (TB) is a condition mostly characterized by breast stenosis, areolar widening and glandular asymmetry. The most accredited hypothesis describes an abnormal thickening of the fascia corporis that might influence an alteration in the glandular development, limiting the horizontal growth of breast parenchyma. Alterations in the extracellular matrix components (ECM) might be involved in the abnormal breast development. PATIENTS: The aim of our case control study is to use histological specimens to analyze qualitative and quantitative differences in collagen fibers, elastic fibers and vessel densities in TB and normal breasts of 20 patients using a software for digital pathology. RESULTS: The quantitative findings showed increasing concentrations of collagen fibers and decreasing elastic fibers in TB, compared to normal breasts. No difference was seen in vessel density among the two groups. The qualitative findings highlighted differences in the distribution of the ECM among the TB specimens. Collagen fibers showed a packed appearance rather a scattered distribution, while elastic fibers visibly presented a reduction and a focal distribution of their concentration. CONCLUSIONS: The study proposes a correlation between abnormalities in ECM concentrations and TB, resulting in a higher degree of fibrosis and in the characteristic stenotic and less elastic morphology of the deformity. 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 .

Treating Anisomastia and Tuberous Breast with Fat Grafting: Technique and Evaluation of Outcomes Using BREAST-Q Surveys.

BACKGROUND: In the surgical correction of tuberous breast deformity, implants and regional flaps play a prominent role. Lately, fat grafting has been used as an alternative, but there is evidence that patient satisfaction is higher after correction with implants compared with lipofilling. METHODS: We report a tuberous breasts correction series of ten cases, enrolled between 2015 and 2018. Percutaneous fasciotomies and fat grafting were performed by the Body-Jet technique. Analysis of outcomes was undertaken with BREAST-Q surveys. RESULTS: The breast satisfaction scores increased from 0 to 75 (p < 0.01), the psychological well-being scores from 20 to 70 (p < 0.01) and the sexual well-being scores from 18.5 to 58 (p = 0.02), while the physical well-being scores remained stable (from 68 to 63, p = 0.2). The median outcome satisfaction score was 86. CONCLUSION: Scores of patient-reported outcomes after lipofilling can reach and even exceed those of patients corrected with implants, at the cost of more interventions. Fat grafting is beginning to establish itself as a true alternative in the treatment of tuberous breast deformity in patients with the appropriate fat deposits. 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .

Circumlateral Vertical Augmentation Mastopexy for the Correction of Ptosis and Hypoplasia of the Lower Medial Quadrant in Tuberous Breast Deformity.

BACKGROUND: Type I tuberous breast deformity (according to Grolleau's classification) is characterized by the hypoplasia of the lower medial quadrant of the mammary gland and ptosis of the lower lateral quadrant. This results in an aesthetic imbalance in the breast that has an unnatural and unattractive appearance. The study aims to propose a surgical technique ensuring the successful correction of hypoplasia of the lower medial gland quadrant combined with ptosis. The essence of the technique is augmentation mastopexy with circumlateral vertical access. In the presence of pronounced ptosis of the breast, it is combined with the horizontal component and rotation of the gland flap. METHODS: The participants in the study were 26 patients (51 breasts) who were treated for type I tuberous breast deformity from 2015 to 2020. The average age of the patients was 34 years (within the range of 27-42 years). Patients from Group I were treated using the technique of circumlateral vertical mastopexy, and patients from Group II using circumlateral vertical augmentation mastopexy with a horizontal component. RESULTS: The average follow-up period was 36 months (9-60 months). Treatment was aimed to correct tuberous breast deformations of type I (according to Grolleau) combined with varying degrees of ptosis. The complication rate for all patients in this study was 5.4%-1 patient (1.8%) had a hematoma, 1 (1.8%) had postoperative implant malposition, and 1 (1.8%) had visibility and palpability of the implant edges. CONCLUSIONS: Circumlateral vertical access can be applied for augmentation mastopexy in patients who wish to simultaneously correct ptosis and type I tuberous breast deformity and perform breast augmentation. 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 .

[Tuberous breast deformity correction: Long-term satisfaction assessment with BREAST-Q questionnaire]. / Correction des seins tubéreux : évaluation de la satisfaction à long terme à l'aide du BREAST-Q.

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 ¼ or « reduction/mastopexy ¼ 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.

Congenital breast deformities: Anatomical basis and surgical approaches for optimal aesthetic outcomes.

Plastic surgeons routinely encounter patients desiring correction of breast asymmetry, hypoplastic growth, or other aesthetic concerns. An appropriate recognition of congenital breast conditions is critical for plastic surgeons. Without consideration of underlying anatomical abnormalities in these patients, surgical intervention may not result in optimal aesthetic outcomes. Often, patients are unaware of their congenital condition and the limitations and difficulties associated with reconstruction must be discussed with the patient preoperatively to ensure optimal aesthetic outcomes. The goal of this article was to summarize the anatomical basis for common congenital breast conditions and discuss options for surgical correction based on the literature and our experience.

Different Types of Breast Deformity Induced by Two Types of Polyacrylamide Hydrogel and Corresponding Treatment.

BACKGROUND: Polyacrylamide hydrogel (PAAG) was once used as an important injection for breast augmentation though it has been banned in China for more than 10 years. Secondary breast deformity after removing PAAG poses a challenging problem. The aim of this article is to introduce types of breast deformity induced by two types of PAAG based on MRI examination and corresponding treatment strategies. METHODS: From 2008 to 2017, 300 patients with the history of injectable PAAG were reviewed. From their medical history, two types of PAAG injections were imported Interfall and domestic Amazingel, 182 patients received Interfall injection and 118 patients received Amazingel injection. MRI was used as a regular examination preoperatively. According to MRI examinations, breast deformities were classified into nodular type, flow type and mixed type. RESULTS: All of them underwent PAAG removal operations. In the 182 patients with Interfall injection: There were only 5 cases of nodular type, 3 cases received immediate breast augmentation and 2 cases received second-stage breast augmentation, and none of cases received breast augmentation; there were 170 cases of flow type, 165 cases received immediate breast augmentation and 5 cases received second-stage breast augmentation, and none of cases received breast augmentation; there were 7 cases of mixed type, 5 cases received immediate breast augmentation, 1 case received second-stage breast augmentation and 1 case did not receive breast augmentation; in the 118 patients with Amazingel injection: There were 111 cases of nodular type, 20 cases received immediate breast augmentation, 51 cases received second-stage breast augmentation and 40 cases did not receive breast augmentation; there were 4 cases of flow type, 2 cases received immediate breast augmentation, 1 case received second-stage breast augmentation and 1 case did not receive breast augmentation; there were 2 cases of mixed type, 1 case received second-stage breast augmentation and 1 case did not receive breast augmentation, and none of cases received immediate breast augmentation . CONCLUSIONS: Breast deformity induced by two types of PAAG can be classified into three types based on MRI examinations, which is very critical for preoperative evaluation and classification. Each type of deformity has its own characteristics, which serves as a guide for whether a first-stage or a second-stage prosthesis implant can be implemented. The proportion of patients who can have breast augmentation in the first or second phase after injection of Interfall is significantly higher than that of patients who have injections of Amazingel. 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.

Complication of Ruptured Poly Implant Prothèse® Breast Implants Combined with AQUAfilling® Gel Injection: A Case Report and Literature Review.

INTRODUCTION: We describe the first case of a patient who received AQUAfilling® gel (Biomedica, Prague, Czech Republic) after augmentation with Poly Implant Prothèse® (PIP) breast implants and later developed breast deformity with bilateral implant rupture. CASE REPORT: A 49-year-old Korean female patient who received breast augmentation with PIP implants 18 years ago and subsequent insertion of AQUAfilling® gel 1 year ago visited our center with a chief complaint of pain and decreased implant sizes in both breasts. Breast implant and foreign body removal operation was performed for both breasts under general anesthesia. Intraoperative gross findings, pathologic findings, and tissue culture results were analyzed. RESULTS: Our diagnosis included rupture of the implants in both breasts with leakage of injected material resulting in inflammation of the pericapsular area and pectoralis muscle. The intraoperative gross findings and results of the pathologic report showed that the implants were exposed with massive leakage of AQUAfilling® gel in the pericapsular space, and the pectoralis major was mixed with AQUAfilling® gel-like liquid and tissue with an inflammatory reaction. CONCLUSIONS: Surgeons should be careful in performing AQUAfilling® gel injection for breast augmentation, especially when combined with breast implant insertion. AQUAfilling® gel itself is not yet proven safe in the long term, so more research on this topic is warranted. Additionally, surgeons should be aware of the comparatively high risk of implant rupture and foreign body reaction with PIP implants, and warn patients accordingly. LEVEL OF EVIDENCE V: 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 .

Male Tuberous Breast: A Rare Variant of Gynecomastia. Clinical Considerations and Personal Experience: Tips and Tricks to Maximize Surgical Outcomes.

INTRODUCTION: Tuberous breast deformity, even rarely, might be observed in the gynecomastia population. It can clinically appear very similar to tuberous breast in females, including a footprint resembling a feminine inframammary fold (IMF). Because of its anatomical characteristics, its correction could benefit from particular surgical measures and therefore it should be careful diagnosed. A clear footprint defining a very feminine inframammary fold is very difficult to correct and renders very difficult the management of the extra skin. Transection of the fibrous constrictions at the level of inframammary fold is not sufficient to obtain a satisfactory result, and adjunctive surgical measurements are required. MATERIALS AND METHODS: From January 2007 to December 2015, twenty-one patients, affected by gynecomastia with tuberous breast deformity, underwent surgical correction consisting of parenchyma debulking and transection of the stenotic fibrous ring of the footprint. The recontouring of the chest profile was optimized using parenchymal flaps which helped to maximize the surgical correction with minimal scarring. RESULT: The mean age at surgery was 28.8 years. The average follow-up period was 32 months. The average hospitalization stay was 1.28 days. Routine laboratory tests and histological examinations did not demonstrate any anomalies. No major complications and no recurrences of the disorders have not been observed. No major complications were reported: one seroma, one skin depression, two scar revisions and three cases of bilateral minimal crescent ptotic skin appearance were observed. CONCLUSION: Although tuberous breast in the gynecomastia population is a rare clinical entity, it should be taken into consideration because it could benefit from some specific surgical measures. The use of glandular flaps showed a satisfactory reshaping of the pectoral area. 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.

Tuberous breast and predisposition to breast deformity in consanguineous.

Tuberous breast deformity is a pathologic condition of the breast consisting of a constricting ring at the breast base, reduction in the volume of the breast parenchyma, and herniation of breast tissue through the nipple-areola complex with areola enlargement. This pathology is generally congenital and has an unknown etiopathogenesis. We report the first observation of tuberous breast deformity in consanguineous. This report suggests the potential role of a genetic base in the development of this deformity. Between May 2008 and March 2011, we observed six female patients from two different families, aged between 18 and 55 years, affected by tuberous breast deformity. The breast deformity was characterized by breast asymmetry in all six cases. Four patients underwent surgery to correct the deformity. Standardized objective measurements of breast and chest were taken. A Visual Analog Scale was used to evaluate patients' and physicians' satisfaction. The first three patients were consanguineous; two were first cousins, and the third was second cousin with one of the above. The other three patients were also from the same family: two sisters and their mother. According to Von Heimburg's classification, the patients presented different degrees of breast deformity. In all operated cases, a good esthetic result with a high satisfaction (average visual analog scale score 9) was achieved. The results remained stable over time and no revisions were needed after the 1-year follow-up. The possibility of a parental consanguinity for breast deformities such tuberous breast has never been described in the literature. This report suggests the possible genetic role in the development of tuberous breast deformity. Further studies and genetic tests are required to prove this hypothesis.

Quantifying Dynamic Deformity After Dual Plane Breast Augmentation.

BACKGROUND: Dynamic breast deformity (DBD) is characterized by visible distortion and deformity of the breast due to contraction of the pectoralis major muscle after submuscular breast augmentation; fortunately, in most cases, this is not a clinically significant complaint from patients. The purpose of this study is to present a simple method for objectively measuring DBD in patients submitted to dual plane breast augmentation (DPBA). METHODS: We studied 32 women, between 18 and 50 years old, who underwent primary DPBA with at least 1 year of follow-up. Anthropometric landmarks of the breast were marked, creating linear segments. Standardized photographs were obtained both during no pectoralis contraction (NPC) and during maximum pectoralis muscle contraction (MPC); measurements of the linear segments were taken through ImageJ imaging software, and both groups were compared. RESULTS: We found statistically significant differences in all analyzed segments when comparing measurements of the breasts during NPC and MPC (p < 0.001). CONCLUSION: Our study proposes a novel, standardized method for measuring DBD after DPBA. This technique is reproducible, allowing for objective quantification of the deformity in any patient, which can be valuable for both patients and surgeons, as it allows for a more thorough discussion on DBD, both pre- and postoperatively, and may help both patients and surgeons to make more informed decisions regarding potential animation deformities after breast augmentation. LEVEL OF EVIDENCE V: 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 .

Management of Tuberous Breast Deformities: Review of Long-term Outcomes and Patient Satisfaction with BREAST-Q.

BACKGROUND: The treatment of a tuberous breast deformity has changed over the years, with a large variety of procedures described. However, maintaining a long-lasting breast contour is an ongoing challenge. The aim of this study was to evaluate the long-term results of tuberous breast corrections, focusing on the incidence of secondary procedures and patient satisfaction. MATERIALS AND METHODS: Forty-six patients who underwent correction of a tuberous breast deformity from 2000 through 2013 were considered. Age, degree of deformity, asymmetry, BMI, pregnancy, first surgical technique used, complications and further surgical procedures were evaluated. Statistical analysis was conducted to identify predicting factors for multiple procedures. Patient satisfaction was evaluated with BREAST-Q. RESULTS: Eighty-eight breasts were treated: 57 breasts underwent implant-based corrections, whereas 31 breasts underwent autologous procedures. A multi-step procedure was initially planned in 7 breasts only, and 41 breasts underwent secondary procedures: 33 out of 53 breasts (62.3%) were re-operated in the implant-based group, whereas 8 out of 28 breasts (28.6%) were re-operated in the autologous group. Statistical analysis showed a correlation between the number of procedures and young age (P = 0.0253) and between the number of procedures and the primary surgical technique (P = 0.0132). The BREAST-Q evaluation suggested that patient satisfaction was comparable. CONCLUSIONS: The question of time is one of the main issues in breast surgery. The management of tuberous breast deformities requires a customized strategy considering all parameters to improve the longevity of the result in the long term. 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 .

Management of Breast Deformity After Removal of Injectable Polyacrylamide Hydrogel: Retrospective Study of 200 Cases for 7 Years.

BACKGROUND: Polyacrylamide hydrogel (PAAG), once used as an injection for breast augmentation, has been banned in the medical field for cosmetic purposes for more than 10 years in China. But a large number of breasts have characteristic deformities due to the gel's feature of erosion. Our aim is to explore a retrospective study on PAAG's long-term effects on women, ensuing breast deformity and the strategy for breast plasticity after removing the gel in our center from 2007 to 2014. METHODS: From 2007 to 2014, 200 patients, whose breasts were injected with PAAG, underwent the operation to remove the injectable material. Complications were summarized. Ultrasound or MRI was performed before the operation to disclose the general distribution of the gel and the muscle and gland infiltration. According to the gel distribution, muscle and gland infiltration, infection, gel residue, and other factors, the patients were treated, respectively, with or without prosthesis implantation surgery after the removal of the gel. According to the decision about whether or when to undergo prosthesis implantation, the patients were classified into three types: group I-prosthesis implantation at the first stage, group II-prosthesis implantation at the second stage, and group III-only removing the material without prosthesis implantation. The scores of the BREAST-Q program were used to evaluate the preoperative and postoperative differences. RESULTS: Seventy-seven patients underwent prosthesis implantation at the first stage and 61 patients were operated on by placing the prosthesis at the second stage. A total of 62 patients only underwent the PAAG removal operation. By BREAST-Q evaluation, changes are summarized in Tables 1, 2, and 3 between mean preoperative scores and mean postoperative scores through categories of satisfaction with appearance of breasts, psychosocial wellbeing, sexual wellbeing, and physical wellbeing, in which all categories were presented with statistical significance (p < 0.001). Table 1 Patient demographics General patient data Number Number of patients 200 Age range 25-48 Follow-up period 6-12 months Injection material  Domestic material 84 (42 %)  Imported material 93 (46.5 %)  Domestic + imported 23 (11.5 %) Injection site  Regular hospital 47 (23.5 %)  Clinics 153 (76.5 %) Complication  Inflammation 10 (2 %)  Pain 75 (37.5 %)  Induration 155 (77.5 %)  Shift 50 (25 %)  Deformation 17 (8.5 %)  Bilateral asymmetry 48 (24 %)  Deposition milk 2 (1 %)  Psychological fear 150 (75 %)  Systemic symptoms 34 (17 %)  Single complication 25 (16.97 %)  Two or more complications 160 (80 %)  Preoperative aspiration 48 (24 %) Table 2 Group I-changes in mean preoperative scores and mean postoperative scores Category Preoperatively (n = 77) Postoperatively (n = 77) p Satisfaction with appearance of breasts 18.8 ± 16.2 81.6 ± 13.1 <0.001 Psychosocial wellbeing 39.5 ± 20.2 84.5 ± 19.3 <0.001 Sexual wellbeing 38.7 ± 23.1 77.2 ± 20.5 <0.001 Physical wellbeing 42.4 ± 16.3 81.7 ± 10.5 <0.001 Table 3 Group II-changes in mean preoperative scores and mean postoperative scores Category Preoperatively (n = 61) Postoperatively (n = 61) p Satisfaction with appearance of breasts 19.6 ± 15.3 82.5 ± 11.1 <0.001 Psychosocial wellbeing 38.9 ± 19.3 83.6 ± 20.1 <0.001 Sexual wellbeing 37.6 ± 22.4 79.3 ± 20.4 <0.001 Physical wellbeing 41.3 ± 15.1 82.2 ± 9.9 <0.001 CONCLUSIONS: Timely removal is critical for women who have received the PAAG removal operation. However, the surgery may destroy the shape of the breast. It is recommended that preoperative communication and local tissue condition are guidelines for surgeons to choose conservative or aggressive surgery. A balance must be maintained between removing the gel as much as possible and retaining soft tissue to reshape breasts. 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 .

The Prevalence of Tuberous/Constricted Breast Deformity in Population and in Breast Augmentation and Reduction Mammaplasty Patients.

BACKGROUND: The exact prevalence of tuberous breast deformity (TBD) has not been properly investigated and still remains undetermined. We report our data about TBD prevalence with the aim of demonstrating its high prevalence. MATERIALS AND METHODS: A retrospective analysis was performed on preoperative photographs of 1600 Caucasian female patients admitted to our department from January 2009 to July 2014 for augmentation or reduction mammaplasty and other breast clinical conditions. The main features of TBD included a contracted skin envelope, a reduction in breast parenchyma of the lower medial and lateral quadrants, a constricted breast base, abnormal elevation of the inframammary fold, herniation of the breast into the areola with a constricted breast base, and nipple areola complex herniation with a normal breast base. Patients were classified into three groups: breast augmentation group (AUG group), breast reduction group (RED group), and general population group (POP group). RESULTS: Four hundred patients were analyzed for each group (AUG and RED group); 194 patients (48.5 %) and 189 cases (47.3 %), respectively, demonstrated at least one tuberous breast deformity; in 800 patients of the POP group, we found 221 patients (27.6 %) with at least one tuberous breast deformity. CONCLUSIONS: Retrospective analysis reveals a high prevalence of TBD in the general population and in particular in women seeking breast augmentation or breast reduction (about 50 %). TBD is characterized by a wide range of clinical features with a spectrum of degrees. Preoperative evaluation is crucial to achieve an optimum outcome and patient satisfaction. LEVEL OF EVIDENCE II: 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 .

[Tuberous breast: Current concept]. / Seins tubéreux.

Tuberous breast deformity is a congenital breast anomaly with different clinical signs. The most consistent sign is the constricting ring at the base of the breast. There is deficiency in the horizontal and/or vertical dimensions of the breast and often herniation of breast parenchyma toward the nipple-areola complex with areola enlargement. Breast asymmetry is frequently associated. This anomaly occurs only in females, during breast development at puberty. The incidence is unknown because of minor forms more difficult to diagnose. This deformity produces psychological morbidity and encourages the patients to consult. In 1999, Grolleau publishes a classification with three types of tuberous breast deformity. The goals of the surgical treatment are the expansion of the constricted base, the redistribution of volume, the correction of areolar size and of herniated subareolar breast tissue. In type II and III, the simple use of breast implant involves the "memory" of the previous inframammary fold line. To avoid this complication, it is necessary to make a glandular rearrangement with parenchymal flaps like Puckett and Ribeiro. It is a real challenge for the plastic surgeon who must reshape the breast and obtain a symmetry of volume. It would be delusive to think all types of tuberous breast can be corrected with the same one-step technique. It is often necessary to plan several surgeries and patient must always be informed about the strategy.

Lipofilling, an efficient solution for breast sequelae after cardiothoracic surgery.

Evolutions in pediatric cardiovascular surgery have allowed the treatment of a various range of cardiovascular malformations in infants. It is a difficult branch of surgery, with vital impact, which can also leave residual thoracic scars, possible sources for thoracomammary deformities in adults. Most thoracomammary deformities after thoracotomy are observed at puberty, when they appear as breast asymmetries. The main cause is the breast bud injured during thoracotomy. Several techniques have been suggested for breast reconstruction, but none give satisfying results. We have been practicing lipofilling since 1998 for breast reconstruction. Since 2001, we have started applying it to breast deformities. The final result is constant in time, natural, and has a good volume filler effect. We describe the fat grafting technique, an original technique, as a solution for this kind of deformities. The technique is illustrated by two clinical cases. In conclusion, fat grafting has really improved breast asymmetry due to iatrogenic deformation. Even if those cases are rare, surgeons have to know this kind of procedure. It is indeed a simple and efficient solution for those patients after childhood, with natural and long standing results.

Custom-made approach to a patient with post-burn breast deformity.

Second and third degree burns on breasts at preadolescent period may cause severe breast deformations. This deformation can be variable depending on severity and location of the burns, personal adolescent patterns, and treatment modality in acute burn period. A 21 year old female patient admitted to our department for her breast deformation due to burn contracture at the inferior pole of the right breast. On physical examination we defined that development of the volume of the right breast was equal to the left, and inferior pole of the right breast was flattened due to contracture, and nipple was projected to inferior. We found that inframammary crease of the right breast was 2 cm lower than that of left; andthe distance of nipple-inframamary crease was 4.7 cm while areola-inframmary crease was 2 cm. New nipple-areola complex level was identified according to left breast's level. Medial and lateral lines were planned to merge inferiorly at 2 cm above inframmary crease in a plan similar to vertical mammaplasty. Superior pedicle carrying nipple areola was desepitelised. Lower parenchymal V flap was transposed superiorly and attached to the pectoral muscle. Inferior parts of the lateral and medial glandular flaps were excised to form new inframammary crease. The desired laxity of skin at the lower pole was obtained by performing a new Z- plasty between lateral and medial skin flaps. Breast symmetry was confirmed by postoperative objective measurements between left and right breasts. Patient's satisfaction and aesthetic appearance levels were high. Breasts deformation patterns caused by burns, trauma and mass exsicion due to cancer could not be addressed with traditional defined techniques. Special deformations can be corrected by custom made plannings as we presented here.