Tuberous Breast Deformity

Tuberous breast deformity, also termed constricted breast deformity, is a condition where the breast tissue failed to develop fully, resulting in a tight lower pole of the breast and wide areolas with the apperance of herniated tissue through the areola. The condition is sometimes accompanied by lack of pectoralis major muscle development, in which case the condition is termed Poland’s syndrome. It may occur on one or both sides but quite commonly there is asymmetry with a form fruste developed on one of the sides or even a completely normally developed breast on one side.

Treatment

Treatment for tuberous breast deformity involves a mastopexy with implants. In some mild cases, implants are not needed but if it is a more severe condition, there is need for volume as the lift will remove too much skin and result in an excessively small breast mound. The correction involves other measures but it can be delineated as follows:

1. Augmentation with a moderately sized saline or silicone gel implant. A saline implant will allow narrow fill changes that discrete silicone sizes may not allow. A dual plane augmentation may provide protection for capsular contracture but this may not always be the case if the pectoralis major is not developed as seen in Poland’s syndrome. A moderate size is important since significant amount of skin will be removed in the lift, and a larger implant may lead to excessive skin tension and wound healing complications or scar hypertrophy.
2. Release of inframammary fold. This step has to be done judiciously as the fibrous tissue forming the inframammary fold may not behave as normal fold tissue and cause a double bubble deformity if released too far inferiorly. A subtle release may allow the implant to move slightly lower with an improved overall shape.
3. Periareolar mastopexy. The periareolar mastopexy has to be designed to lift the nipple-areolar complex a symmetric amount on both sides. With asymmetries, this may mean a significant difference in the excision patterns between breasts. In order to avoid asymmetries, the closure has to be carefully protected with a round-blocking suture to avoid areolar widening of one side over the other and a relapse of asymmetry. The more traditional vertical mastopexy will not usually work in these cases due to the tight lower pole constriction and lack of supple skin excess in the lower pole of the breasts.