Congenital Breast Reconstruction Mobile
Polymastia is the presence of an extra breast and exists in 1% of people. This is additional breast parenchyma and glands with or without a nipple along the fetal milk line which extends from the armpit (most common location) to the groin. These areas of breast tissue may be uncomfortable, interfere with clothing, or be unattractive in addition to the potential for benign and malignant breast diseases. Treatment includes liposuction for small deposits or excision for larger areas, loose skin, or accessory nipples.
Polythelia is the presence of accessory nipples along the same milk line without breast tissue and with or without surrounding dark areolar skin, occurring in up to 2.5% of the population in both sexes. Removal can be done in the office with local anesthesia but will leave a scar.
Flat or inverted nipples are due to tethering of the nipple by short underlying ducts. Outside the US, a suction device is available over-the-counter which provides correction for several hours at a time. Surgically these can be treated by incising the areolar skin and dividing the tethered ducts, but in females this can impair the future ability to nurse.
Enlarged nipples may be surgically corrected. Long nipples can be shortened. Dr. Park prefers to barrel sleave the nipple to shorten it preserving ducts. A simpler technique is resection of the tip of a long nipple but this does cut many ducts. For excessive girth of nipple, treatment involves reducing the circumference of broad nipples.
Enlarged areola, the darkened skin around the nipple, may be surgically corrected by removing the outer rim and tightening with a pursestring type of suture.
Athelia is the absence of the nipple and is very rare, but is usually seen with absence of the underlying breast, amastia. Absence of the breast gland with a nipple is termed amazia, which may be seen in adolescents if breasts develop at different times. If true absence is determined, treatment is an expandable prosthesis that can be inserted underneath the skin and/or muscle and adjusted to the developing contralateral breast until a permanent implant or autologous tissue flap is placed at breast maturity.
Tuberous breast deformity is characterized by smaller breasts with a tight, constricted base and herniation of breast tissue with a large areola and elevated inframammary fold. The problem is usually bilateral but asymmetric. Correction includes areola reduction with a circumferential excision and tightening, disruption of the constricting ring of fascia, and tissue expansion or augmentation. This will result in scars extending circumferentially around the areola at its junction with the skin and a formal mastopexy or breast lift when necessary. In severe cases, two surgical stages are often necessary.
Poland syndrome is characterized by underdeveloped chest muscles (especially the sternocostal head of the pectoralis major muscle) and breast, sometimes with rib or upper extremity anomalies. Breast reconstruction is completed in late adolescence in severe cases with an expander and eventual implant or later with an immediate implant in milder cases. The underdeveloped pectoralis muscle can be reconstructed by rotating the latissimus dorsi muscle from the back which in addition to restoring muscle function, provides bulk, recreates the anterior axillary fold, and covers any implants. Solid silicone implants may be used to augment deficiencies of ribs, sternum, clavicle, and muscle through an incision approximately 5-8 centimeters in length. Drains are occasionally used for 3-5 days. Sutures are maintained for 1 – 2 weeks. Recovery is fairly rapid but strenuous activity is limited for 3 – 4 weeks.
Pectus Excavatum, also referred to as funnel chest, is abnormal cartilage that results in a depression of the sternum and the mid-chest. Severe cases may displace the mediastinum and lungs, causing physiological compromise, usually presenting as exercise intolerance. These cases are best treated with thorough preoperative testing and bone remodeling by a cardiothoracic surgeon, either removing and inverting the sternum or placing a bar beneath the sternum to elevate the midchest. Cases without physiological compromise can be treated by Dr. Park for aesthetic concerns with minimal risk. In females, the defect may be camouflaged with breast augmentation. In men and severe female cases, a solid silicone implant that is custom molded is placed through limited incisions under the skin and edges of the pectoralis muscles.
Pectus Carinatum is characterized by abnormal elevation of the sternum, commonly referred to as pigeon chest. Surgical correction involves resection of excess sternum, typically by a cardiothoracic surgeon.