Breast-Related Herniation: A Call for Multidisciplinary Awareness and a Proposal for a Classification.

Breast-related herniation (BRH) is a vague term for many clinicians. The absence of a universal nomenclature and the different nature of the herniation process involved, being true or false, contribute to this vagueness. BRH includes a spectrum of disorders ranging from a few congenital breast disorders to commoner herniation processes related to acquired breast diseases. We aim to raise multidisciplinary awareness about BRH by reviewing the related literature and reviewing our experience with BRH. We will also propose a classification for BRH. PubMed and Scopus databases were searched for any herniation disorders that are related to the breast in any clinical or pathological aspect. The literature review revealed 12 various groups of BRHs that we could classify into two anatomical categories: pectoral (mammary) BRH, in which the herniations occur at the pectoral site of the chest wall, and extra-pectoral BRH, in which the herniations occur at an extra mammary site but are related to breast pathologies. Pectoral BRH was further divided into clinicopathological subcategories, including congenital BRH, pulmonary BRH complicating breast cancer and breast infections, factitious BRH, and iatrogenic BRH. Extra-pectoral BRH was further divided into clinicopathological subcategories, including abdominal wall hernias following autologous breast reconstruction (ABR) and herniated siliconomas. Our study group included 19 patients with BRHs, among which congenital BRHs and pulmonary BRHs were the most common. Congenital BRHs are rare and are of main interest to plastic surgeons. However, abdominal wall hernias following ABR, pulmonary BRH, and factitious BRHs are relatively common complications of breast cancer treatment. This calls for a multidisciplinary approach to ameliorate the morbidity of BRHs. Further studies are needed to refine our proposed classification.