Invited Discussion on: Quantitative Analysis of Nipple to Inframammary Fold Distance Variation in Tuberous Breast Augmentation: Is There a Progressive Lower Pole Expansion?

Tuberous breasts are a congenital anomaly in which the breasts fail to develop normally. This abnormality may include hypoplasia, a tubular appearance, a higher inframammary fold (IMF), and sometimes a herniated nipple-areolar complex. Correction of tuberous breast deformity (TBD) is traditionally done with a 1-stage breast augmentation with radial scoring of the constricted breast tissue and/or the lowering of the IMF. An alternative 2-stage approach first uses a tissue expander to correct the deformity; the expander is later replaced with a permanent breast implant. Sixteen patients are presented in which a 1-stage correction of TBD was successfully accomplished with saline implants acting as tissue expanders. In all cases, the expansion remedied the deformity without the need for radial scoring of the breast tissue or lowering of the IMF. This approach has not been reported in the literature. Sixteen women (32 breasts) were treated, with TBD ranging from mild to severe. All patients had a breast augmentation with round, smooth saline implants placed through an IMF incision in the dual plane (partially subpectoral and partially submammary). Implants ranged in size from 225 cc to 675 cc. The IMF was never lowered and the breast parenchyma was never radially scored. Three patients had asymmetry requiring breast implants of different sizes, and one had a circumareolar mastopexy to repair a herniated areolar complex. Representative case examples are provided. The average follow-up time was 9 months. All deformities were corrected, and the patients expressed satisfaction with their results. There were no occurrences of hematoma, infection, capsular contracture, or malposition. This review has shown that saline breast implants alone, with their inherent expansion capability, can correct TBD without the increased morbidity associated with radial scoring and lowering the IMF. For patients who choose saline implants, this single-stage, less invasive surgical approach can provide a good aesthetic result.

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Polyurethane-Coated Implants for Prevention of Double-Bubble Effect in Breast Augmentation

Plastic Surgery Case Studies ◽

10.1177/2513826x211028926 ◽

2021 ◽

Vol 7 ◽

pp. 2513826X2110289

Author(s):

Vitali Bagirov

Keyword(s):

United States ◽

Breast Augmentation ◽

Cosmetic Surgery ◽

The United States ◽

Treatment Result ◽

Lower Pole ◽

Common Complication ◽

Breast Volume ◽

Double Bubble ◽

Growing Body

Breast augmentation is the most frequently performed cosmetic surgery in the United States, with approximately 279,000 patients every year. The so-called double-bubble effect (DBE) is a common complication in breast augmentation. This complication is characterized by folds running along the lower pole of the breast, forming distinct bubble-like protrusions above and below the fold. Factors that increase the risk of DBE include bulbous breasts and a large native breast volume. There is evidence that polyurethane-coated (PU) implants may help to reduce the risk of DBE. We describe here the case of a 47-year old patient for whom DBE has recurred in each of 4 tandem breast surgeries. PU implants ultimately appeared to prevent the DBE, leading to an aesthetically satisfying treatment result for the patient. This case adds weigh to the growing body of evidence that supports the use of polyurethane implants to prevent DBE.

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Contribution of breast skin elastometry measurement in breast augmentation surgery: A pilot study evaluating the correlation between skin elasticity and nipple-to-inframammary fold distance

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2015.05.008 ◽

2015 ◽

Vol 68 (9) ◽

pp. 1309-1310 ◽

Cited By ~ 1

Author(s):

Rémi Foissac ◽

Olivier Camuzard ◽

Charalambos Georgiou ◽

Pauline Foty ◽

Thierry Balaguer ◽

...

Keyword(s):

Pilot Study ◽

Breast Augmentation ◽

Inframammary Fold ◽

Skin Elasticity

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Congenital deformities of the breast

10.1093/med/9780199682874.003.0085 ◽

2021 ◽

pp. 1007-1016

Author(s):

Michelle L. Lodge

Keyword(s):

Congenital Anomaly ◽

Mammary Gland ◽

Breast Augmentation ◽

Breast Tissue ◽

Tissue Expansion ◽

Poland Syndrome ◽

Tuberous Breast ◽

Congenital Deformities ◽

Mammary Gland Tissue ◽

Tuberous Breast Deformity

Congenital breast anomalies include supernumerary nipples (polythelia) and supernumerary breasts (polymastia) which can be generally found on the embryonic mammary ridge. Absence of the breast occurs less frequently and varying presentations of absence of nipples only (athelia), absence of mammary gland tissue (amazia), or absence of the entire breast (amastia). Tuberous breast deformity is a common congenital anomaly with varying degrees of constriction, hypoplasia, areolar herniation, skin deficiency, and asymmetry. Treatment consists of breast augmentation, either primarily or after tissue expansion, in combination with mastopexy. Gynaecomastia is the development of breast tissue in males. The aetiology is diverse and includes physiological, pathological, acquired, drug-related, and idiopathic causes. Poland syndrome is discussed elsewhere (Chapter 9.2).

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Constricted Breast Deformity in Augmentation Mammoplasty

The American Journal of Cosmetic Surgery ◽

10.1177/074880689801500304 ◽

1998 ◽

Vol 15 (3) ◽

pp. 237-249

Author(s):

William Yvorchuk

Keyword(s):

Breast Augmentation ◽

Treatment Programs ◽

Augmentation Mammoplasty ◽

Clinical Classification ◽

Tuberous Breast ◽

Breast Deformity

There has been a resurgence in the demand for elective breast enhancement over the latter portion of this decade. Endoscopic technology has expanded the techniques available for breast augmentation, and treatment programs for a number of breast deformities have been elucidated. The constricted and tuberous breast deformities have previously been defined, but there appears to be a lack of recognition of minor variations of the constricted breast deformity and, to date, there has been no satisfactory clinical classification of this relatively common entity. A proposal for the classification of the constricted breast deformity is presented along with a recommendation on the possible treatment for different variations of the deformity.

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Augmentation Mastopexy With Surgical Excision of the Lower Pole to Avoid Waterfall Deformity: A Surgical Technique and Nipple Areolar Complex Case Series

Plastic Surgery ◽

10.1177/2292550320933662 ◽

2020 ◽

pp. 229255032093366

Author(s):

Colin P. White ◽

Brian D. Peterson

Keyword(s):

Surgical Technique ◽

Breast Augmentation ◽

Capsular Contracture ◽

Case Series ◽

Senior Author ◽

Complex Case ◽

Silicone Implants ◽

Lower Pole ◽

Areolar Complex ◽

Augmentation Mastopexy

Purpose of this article is to demonstrate a way of avoiding the waterfall deformity in augmentation mastopexy patients. We will show a case series of results and explain how this technique gives satisfying aesthetic results for patients seeking breast augmentation who also require mastopexy. We will show how addressing the breast parenchyma on the lower pole via direct excision can give reliable results and avoids the waterfall deformity. The surgical technique used by the senior author combines the principles of breast augmentation, mastopexy, and breast reduction. We apply these principles during the initial single operation. Our goal is to achieve the best anatomical results for the patient. We describe 1538 consecutive patients whom underwent single-stage breast augmentation with mastopexy. All implants were submuscular with 12% being saline and 88% were silicone implants. Vertical mastopexies were performed in 8% and wise pattern incisions were used in 92%. There were no life-threatening complications such as deep vein thrombosis, pulmonary embolism, and so on. Tissue-related complications included wound infection (1%) and hematomas (1%). Implant-related complications included malposition or implant displacement 9% and capsular contracture 1%. Aesthetic complications included dystopia of NAC (4%) and volume asymmetries (10%). Revision surgery was tissue related (2%), implant related (3%), and aesthetic related (10%). There were no cases of waterfall deformity seen in the cohort. In conclusion, we believe that the technique detailed here is easy to do, uses principles already known of breast augmentation and reduction and gives consistent results with low reoperation rates.

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The Use of GoreTex in Reconstruction of the Inframammary Fold

The American Journal of Cosmetic Surgery ◽

10.1177/074880689301000405 ◽

1993 ◽

Vol 10 (4) ◽

pp. 249-253 ◽

Cited By ~ 2

Author(s):

Howard A. Tobin ◽

George T. Goffas

Keyword(s):

Breast Augmentation ◽

Breast Implants ◽

Inframammary Fold ◽

Previous Attempt ◽

Common Complication

Inferior displacement of breast implants is a relatively common complication of breast augmentation. The authors describe the use of GoreTex® in the repair of a case that failed after a previous attempt at correction. Possible mechanisms that might lead to this complication are reviewed along with a discussion of the anatomy of the region of the inframammary fold

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