The strong points
- Reduction of breast volume and ptosis
- Procedure covered by social security under certain conditions (removal of 300 g per breast operated)
- High patient satisfaction
Main known malformations
Breast deformities are frequent and are responsible for significant functional and psychological discomfort for patients.
The treatment of a breast deformity is based on a precise diagnosis of the deformity in order to propose the most appropriate surgical technique.
Breast deformity surgery is covered by the health insurance.
This malformation can be classified according to three stages which are subject to different surgical methods.
The anomaly common to all tuberous breasts is an anomaly of the base of the breast: it takes on the appearance of a tubercle. Most often the portion of the breast located under the areola is poorly developed, which causes the breast to tilt downward.
Other criteria for tuberous breasts are:
- A high position of the submammary fold
- Abnormalities of the areola-nipple plate: it is always large in relation to the volume of the breast.
- Breast volume abnormalities. The breasts are most often hypotrophic (A cup) but they can be of normal volume and sometimes even hypertrophic;
- Breast asymmetry is present in more than two thirds of cases.
Both breasts are usually tuberous and all grades can be associated.
The treatment of this malformation aims to obtain the most natural and symmetrical breast possible. Fat injection or Lipofilling has revolutionized the treatment of this malformation. We systematically perform at least one session of fat injection in order to give volume to the lower portion of the breast that is poorly developed. A second intervention then consists in the installation of silicone prostheses or a new injection of fat according to the case.
Poland syndrome combines breast hypoplasia with a thoracic malformation of variable size and sometimes with upper limb anomalies.
The minimal expression of the thoracic malformation is the absence of the sternocostal portion of the pectoralis major muscle.
The mammary gland is usually hypoplastic, sometimes totally absent.
The nipple-areolar plate is usually small in diameter, located superiorly and laterally, and may even be totally absent.
The surgical treatment of Poland syndrome is complex. In moderate forms, implantation of a breast prosthesis may be associated with a subclavicular prosthesis or lipofilling, or even with transposition of the dorsalis major muscle. The treatment of major forms of Poland syndrome is difficult and is based on techniques derived from breast reconstruction after cancer. We currently favor treatment by repeated lipofilling.
A breast asymmetry is considered by the social security as pathological if it requires a compensation of one cup or more in the bra. Breast asymmetry is most often congenital but can also result from the aftermath of an infection, surgery or even breastfeeding. In moderate cases, lipofilling is not recommended; in more marked cases, lipofilling is combined with the placement of a breast implant. Sometimes, one of the two breasts is hypertrophied and drooping. In this case, we perform a breast reduction surgery with T-shaped scars.
An invaginated nipple is a common condition that appears to be benign but has a very important functional or psychological impact.
Medical treatments are available but are quite restrictive. A simple surgical treatment can effectively solve this problem.
Principles of invaginated nipple treatment
An invaginated nipple is defined by the nipple turning inwards into the areola. This condition can be reversible or permanent. This unsightly condition can be painful and prevent breastfeeding. The absence of a nipple can have an important impact on body image and sexual life.
There are many causes. They include hypertrophy of the smooth muscle fibers of the areola as well as retraction of the fibrous partitions that surround the galactophores (ducts that bring milk to the nipple).
Medical treatment by suction is available. The Philips Niplette® system gently promotes nipple eversion, especially during breastfeeding. If there is significant hypertrophy of the smooth muscle fibers of the areola, we combine this with a subcutaneous injection of botulinum toxin or Botox.
However, stopping its use often leads to recurrences.
Surgery is therefore indicated in case of failure of the medical treatment, especially if breastfeeding is not envisaged afterwards.
There are 2 main types of surgical techniques:
- A flapless technique: the nipple is disinvaginated, then incised in its center. The fibrous trabeculae are incised on each side, then the gland is re-adjoined to support the nipple. This is a simple technique, without scars but with a 10% risk of recurrence. Breastfeeding is impossible after this surgery.
- A technique with flaps. 2 triangles of areola are lifted on both sides of the nipple. Their skin is removed and then they are buried in the nipple to stabilize it. It is possible to consider breastfeeding with this technique. Recurrences are very rare. The disadvantage is the presence of two scars and the possible deformation of the areola.
The procedure can be performed under local anesthesia with sedation (neuroleptanalgesia). It can be performed as an outpatient surgery, or even in the office under pure local anesthesia.
No time off work is necessary. It is imperative to stop smoking at least one week before and 15 days after the operation.
The diagnosis of the malformation often requires additional examinations.
If a thoracic malformation is associated, a CT scan is requested in order to perform a 3-dimensional reconstruction.
If a fat injection is considered, a digital mammogram and a breast MRI are prescribed.
Questions / Answers
Is breast deformity surgery covered by health insurance?
Yes, but only after the opinion of the doctor advising you on social security, especially if breast implants are being considered. His consultation is mandatory before the operation and is requested by a request for prior agreement given by your surgeon.
The treatment of invaginated nipples is covered by health insurance after the failure of medical treatment.
How much does surgery for a breast deformity cost?
It all depends on the complexity of your case.
An advanced Poland syndrome may require a custom-made thoracic prosthesis followed by 2 to 3 fat injections.
We charge additional fees that vary from 1000 to 3000 € for each step of the reconstruction.
A precise treatment plan with estimates for the interventions will be given to you before any surgical treatment.
For an intervention of a unilateral invaginated nipple our fees are 800 €. In case of an intervention on both nipples, our fees are 1200 €. These fees may be covered by your complementary health insurance.
What are the possible complications of an invaginated nipple cure?
Partial or complete necrosis of the nipple may occur, especially if smoking has not been stopped prior to surgery.
Most surgical techniques prevent subsequent breastfeeding.
Problems with the sensitivity of the areola and nipple may persist for 6 months after surgery.
Have a question? Please contact us!
Docteur Yaël Berdah and Docteur Marc-David Benjoar
Plastic surgeons in Paris France