They include a multitude of malformations, from simple hypoplasia to severe abnormalities, which are conformation disorders. These abnormalities create breast asymmetries. The aim of plastic surgery is therefore to restore the breasts and achieve symmetry.
A) atrophic type anomalies: – amastia – aplasia – hypoplasia (unilateral or bilateral) B) hypertrophic type anomalies – polymastia – asymmetric hypertrophy We will refer to the most characteristic breast anomalies.
Characterized by unilateral, complete absence of only the mass gland. There are morphological alterations of the hemithorax due to the lack of pectoral muscles. This deformity is called POLAND syndrome. The repair is achieved surgically, using a muscle (dorsalis majoris muscle) to cover the deficit and an appropriately sized silicone insert.
Can be unilateral or bilateral. It is characterized by the presence of all the anatomical elements of the breast, but they are underdeveloped. In unilateral hypoplasia, there is a normally developed breast and a hypoplastic breast. The “normal” breast will be used as a “model guide” for the formation of the hypoplastic breast. It is, of course, possible for the normal breast to show some degree of droop or hypertrophy. In these cases, the shaping of the breast should be preceded and followed by correction of the hypoplastic breast in order to achieve symmetry. A typical example of hypoplasia is the “tubular breasts”. They were first described in 1976 (Rees-Aston). Depending on the degree of hypoplasia, 3 forms can be distinguished. The existence of a ricnotic fibrous ring at the base of the breast prevents both its horizontal and vertical development and leads to a tubular shape of the breast. The Nipple-areola complex may be larger in relation to the size of the breast, with the hypomastoid line at a higher level. Many surgical methods, have been described to correct this deformity. The most promising of these involves a peripapillary approach to the breast, division of the ricinous fibrous ring, redistribution of the parenchyma and, as a rule, placement of a silicone prosthesis. The results of the method are very satisfactory.Bilateral hypoplasia with asymmetry can affect both the diameter and the projection of the breasts. The placement of different sized silicone prostheses solves the problem. Polymastia is a rare congenital anomaly characterized by the presence of a supernumerary breast, most often located in the axilla. This breast is surgically removed. Hypertrophy of the breasts, as well as the combination of hypertrophy and hypoplasia, are treated surgically with the common goal of obtaining symmetry. More information on this subject is given in the section on breast reduction. This method exploits the ability of the skin to grow progressively like the skin of the abdomen during pregnancy. The skin expander is placed either directly at the same time as the mastectomy, or later without further incisions than the mastectomy incision, under the pectoralis major muscle. Through a small valve placed under the skin, the skin is periodically stretched until it fills up after a few weeks or months. When the skin is sufficiently stretched the dilator is removed in a second operation and the permanent insert is placed. Some expanders are designed to stay permanently. In a second phase, the nipple-areola complex is created. Some patients do not need dilatation and the doctor can place the insert in the first operation.
When we also need skin for breast reconstruction we use the flat dorsal muscle from the back together with a skin island. The muscle along with a spindle-shaped skin island is transferred through a tunnel made under the skin of the axilla to the anterior chest wall to create a sheath for the prosthesis or expander to be placed. The disadvantage of this method is the creation of a new scar on the back, more scars on the breast and discolouration in the breast area as the skin of the back is not the same colour as that of the anterior chest wall. On the back the wound is closed with a horizontal incision. This method is usually used when radiotherapy has been applied to the skin of the anterior chest wall.
In this method we do not use an insert. The method is ideal for patients who have some excess fat and skin on the lower abdominal wall. It makes it possible to restore even a massive ptotic breast with a more natural shape than an inlay. The skin and fat of the abdomen are transferred through a tunnel created under the skin along with the rectus abdominis muscle and its vessels. The abdomen is left with a horizontal scar identical to the classic abdominoplasty incision. The disadvantages of this method are the heaviness of the operation and the long stay in the clinic as well as new scars on the abdomen and breast. The advantages are that the result is more natural especially if the breast to be restored is massive. In the 2 methods described above, the muscle and tissue were transferred through a tunnel and without being detached from the donor area. In another technique the tissue was surgically transferred and transplanted into the chest by reconnecting its vessels to the vessels of the chest wall using microsurgical techniques. Often after breast reconstruction, an operation on the other breast is necessary (reduction, mastopexy, augmentation) in order to obtain a symmetrical breast. Six months after breast reconstruction, a second operation is performed to create the nipple and areola. This is done under local anesthesia and we usually take a skin graft from the femoral crease to create the areola and use a local flap to restore the nipple.
