Breast malformation

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:

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:

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.