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Correction of breast asymmetries and malformations


   Among the not infrequent malformations of the nipples the removal of the supernumerary or so-called accessory nipples is a simple task in the plastic surgery, where leaving the least disturbing scar is important. Much more frequent are the aesthetic and/or breast-feeding problems due to inverted or retracted nipples, which can be corrected by outpatient surgery mainly under local anesthesia.
A fundamental demand at the careful and precise correction of the inverted/retracted nipples is not to damage the outlets of the milk ducts. Making fine, later hardly noticeable scars inside the areola the dermis can be turned under the nipples, among the milk ducts, that will bring the nipples out of their inverted position. The result depends also on the starting condition.

 
 
Inverted (upper left) and duplicated (lower left) nipples. Supernumerary nipples along the embryonic “milk lines” (right) – just like at mammals.


It is not a rare congenital malformation, when besides the absence of the pectoral muscle the complete glandular tissue of the breast is missing – this is called the Poland (or Amazon) syndrome. This might go together with the absence of the nipple. It is also often associated with the malformations of the vertebral column, ribs, chest or upper limbs of the same side. This malformation can be recognized already in early childhood and it is useless to hope that the breast “will grow out” after puberty – since there is no glandular tissue at all.


 
 
Photos of Poland (Amazon) syndrome


A complete correction is suggested after the full development of the healthy breast on the other side, at the age of 17-19, with an implant placement. If the pectoral muscle is missing, the rotation of one of the wide back muscles (latissimus dorsi) on the same side is required before the implant placement of women. This we can carry out with the shortest scars under the strap of the bra on the back and hardly visible ones in the armpit by our endoscopic method, in narcosis. By the muscle rotation the implant doesn’t get directly under the skin. For men the muscle rotation alone is certainly enough. It would be good, if the muscle rotation could be carried out already in childhood, so the dented chest wouldn’t bother the patient in puberty. Unfortunately, the pediatricians and pediatric surgeons do not know that the possibility for this exists. With such operations the condition poisoning the patient’s life could be spectacularly corrected.


 

Congenital malformation with missing glandular tissue and areola on both sides – chest of a female patient


The most common breast malformation is, that the form and size of the two breasts is different beginning from puberty, namely there is some kind of breast asymmetry present. Depending on the extent of the deformity, age, chest anatomy and personal wish, various but always individually planned solutions should be given, sometimes with the correction of only one, more frequently of both breasts. This might mean a breast augmentation on one side (possibly with a mastopexy) and a breast reduction on the other side, or even the combination of breast augmentations to different measures. This time, after creating the ideal-aesthetic breast shape, the patient’s life changes radically, the psychic inhibitions because of the prior malformation disappear, finally she can dress the way she always wanted to and can look for the partner for life.


 

Imperfectly developed, asymmetric tubular breasts


 

Tubular, underdeveloped, asymmetric breasts


Nowadays extensive difference in the volume of the breasts can be corrected with special implants, which have a double chamber; the outer one contains a gel of natural touch and the inside can be filled with a saline solution through a remote dome. These are the postoperatively adjustable size implants. The remote dome is placed under the skin of the armpit at the operation, and after the wound healing and when the swellings are gone, standing before the mirror even the patient can participate and give her opinion how much and in what proportion to each other shall we increase the size of her breasts until the final result is reached on both sides and the asymmetry is corrected – and this is not more uncomfortable than a pin-prick. After several sessions that take weeks or maybe months, the remote dome can be removed by a small operation, and the implant will guarantee the final result.


 

The Becker postoperatively adjustable size double chamber breast implants with remote injection dome – product of the MENTOR Company.



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