Pacifico Marc D, Kang Norbert V
Department of Plastic & Reconstructive Surgery, Mount Vernon Hospital, Northwood, Middlesex HA6 2RN, UK.
J Plast Reconstr Aesthet Surg. 2007;60(5):455-64. doi: 10.1016/j.bjps.2007.01.002. Epub 2007 Feb 21.
The tuberous breast presents a problem for which many surgical solutions have been described. Current teaching describes how the tuberous breast deformity is the result of skin shortage as well as herniation of breast tissue through the nipple-areola complex. However, through careful clinical observation we now believe that the only abnormality present is herniation of breast tissue through the nipple-areola complex.
Using this principle, we have refined a one-stage surgical procedure that can be used to correct any type of tuberous breast deformity. Since 2001 we have performed our technique on a series of 13 tuberous breasts of widely varying appearances in eight patients (age 17-24 years) with a follow up varying between 3 and 56 months. Our new understanding of the tuberous breast deformity has also made it possible to develop an objective, reproducible method for defining the tuberous breast based on the degree of areola herniation.
All patients reported high levels of satisfaction with the procedure. Assessment of the results by an independent panel of attending surgeons showed all results to be good/excellent. Moreover, the results have improved with time and no revisions have been needed. Our method of defining the tuberous breast (based on the ratio of areola herniation:areola diameter) enabled us to identify a cut-off to decide (objectively) when a breast was tuberous. This allowed us to anticipate when an areola reduction/tightening procedure would be necessary to avoid a 'double-bubble' deformity.
We propose a one-stage surgical procedure which is applicable to all degrees of tuberous breast deformity. The results appear to confirm our theory that the only abnormality present in the tuberous breast is herniation of breast tissue through the nipple-areola complex. In patients with small breasts and a tuberous deformity, correction of the herniation changes the tuberous breast into a simple hypoplastic breast. The volume deficit can then be corrected by augmentation (if desired by the patient). In patients with sufficient breast volume, correction of the herniation alone will correct the deformity.
乳房呈管状是一个存在多种手术解决方案的问题。当前的学说描述了管状乳房畸形是皮肤短缺以及乳腺组织通过乳头乳晕复合体疝出的结果。然而，通过仔细的临床观察，我们现在认为唯一存在的异常是乳腺组织通过乳头乳晕复合体疝出。
基于这一原理,我们改进了一种一期手术方法，可用于矫正任何类型的管状乳房畸形。自2001年以来，我们已将该技术应用于8例患者（年龄17 - 24岁）的13个外观差异很大的管状乳房，随访时间为3至56个月。我们对管状乳房畸形的新认识也使得基于乳晕疝出程度开发一种客观、可重复的定义管状乳房的方法成为可能。
所有患者对该手术的满意度都很高。由独立的主治外科医生小组对结果进行评估，显示所有结果均为良好/优秀。此外，随着时间推移结果有所改善，无需进行修正手术。我们定义管状乳房的方法（基于乳晕疝出:乳晕直径的比例）使我们能够确定一个界限，以（客观地）决定乳房何时为管状。这使我们能够预测何时需要进行乳晕缩小/收紧手术以避免“双泡”畸形。
我们提出一种适用于所有程度管状乳房畸形的一期手术方法。结果似乎证实了我们的理论，即管状乳房中唯一存在的异常是乳腺组织通过乳头乳晕复合体疝出。对于乳房较小且有管状畸形的患者，矫正疝出可将管状乳房转变为单纯的发育不全乳房。然后可通过隆乳术（如果患者有此需求）矫正体积不足。对于乳房体积足够的患者，仅矫正疝出即可矫正畸形。
