The tuberous breast is a malformation that occurs from pubertal development may affect one or both breasts. It is characterized by a constriction of the breast and basa herniation of breast tissue above the same. The resulting deformity is very important as it affects the patient psychologically.
Developed a breast can be seen in its vertical axis, with a high mammary groove, and to herniate the glandular tissue to the areola important causes distension of the same.
Grolleau determined 3 degrees of deformity:
- Grade I: Equivalent to 56% of cases. the lack development is limited to the infero-internal quadrant. The areola is deflected downward and inside, with the volume of the normal breast or hypertrophic.
- Grade II: Equivalent to 26% of cases. The two lower quadrants are deficient in their development. In these cases the areola is offset at the bottom.
- Grade III: Equivalent to 18% of cases. all quadrants are affected and are deficient, the base is retracted breast and breast looks like a tuber or goats.
Surgical treatment will vary depending on the severity of the malformation and acted about: The size of the areola with a periareolar incisición to remodel your size over the groove to demote breast and place in a correct position regarding the areola nipple. and redistributing breast volumes. This will be done with tissue flaps gland to be shifted to the lower pole, or when necessary the implantation of a breast prosthesis.
The patient should know the location of the scar is around the areola and in the severe cases almost always causes stretching of the same. Lactation may be altered if necessary the mobilization of significant glandular tissue flaps.
Type of anesthesia: If the operation is to reshape the size of the areola can be done under local anesthesia. For implantation of breast prostheses and flaps of tissue remodeling glandular prefer general anesthesia.
Forms of hospitalization: a day is enough hospitalización in cases of general anesthesia.
The post-operative can be painful the first few days, especially when the implant is behind the pectoralis major muscle, so it resorts to analgesic treatment. in some cases, the patient will feel a strong sense of tension. Edema (swelling) and ecchymosis (bruising), breasts, and trouble in lifting arms are frequent principle.
The first dressing is removed after 24 to 48 hours and is replaced by a bandage lighter, making a sort of spring clip as.
The discharge is given to 24 or 48 hours after surgery and the patient is reviewed in consultation two or three days afternoon: then puts on a bra that provides good containment. this bra is recommended for a month take day and night.
The sutures if not absorbable, are removed between 8 and 15 days post-op. Arrange an convalescence and a low of approximately 7 working days. It is advisable to wait a month to take up a sport.
Scar may have an abnormal evolution, thickening or retranyéndose. the breast pain and changes in nipple sensation are possible. On the other hand, the dissatisfaction can motivate aesthetic result reoperation for improvement.
The post-operative is generally simple, however complications may occur some inherent interventions linked to breast and other implants.
1 / Complications inherent in breast interventions: Infections treated with antibiotics and sometimes with surgical drainage. Hematoma may need to evacuate. Alterations in sensitivity, essentially the nipple can be seen, but normal sensation returns in a period 6 to 8 months. The evolution does not always have scars that may be favourable existing hypertrophic scars and even keloids, unpredictable onset and progression can compromise the aesthetic appearance of the result and requires specific local treatment long.
2 / Specific risks of breast implants: They are of three types which vary according the nature of the filling of the implant. This is the formation of folds or waves, producing a capsular contraction periprothésic and the risk of rupture or Deflation:
- Fold formation or appearance of waves. The implant for smooth never full tension. From this fact, the folds of the coating of the prosthesis may be visible under the skin, thereby producing wave aspect especially in the upper outer and bottom of the breast. This in more noticeable in the upper part in the event that the prosthesis is placed in position retro muscular. This phenomenon is more common when the prosthesis is filled with saline solution, even if it is textured. This puts even greater risk breaking and deflated by spending premature coating level of the fold.
- Contraction capsular fibrous capsule. Forming a fibrous capsule around the implant always occurs. Is a normal reaction of the organism that produces a sort of membrane around any foreign object to isolate and protect (“membrane or capsule of exclusion”). in certain cases, this membrane has a poor outcome comparable to skin keloids: increases in thickness, shrinks and forms a true fibrous capsule around the implant. It This capsular contraction. There are four stages of hardness ranging from the appearance normally undetectable to severe forms of breast capsule with hard, round, and sometimes fixed painful. The frequency of this complication can not be estimated as it varies globally depending on the indication, type of prosthesis and surgical technique. This complication is most frequent in the case of prostheses filled with silicone gel. The capsule does not increase the risk of rupture but exposed to a complication of an aesthetic nature. Surgery can correct this complication sectioning the capsule (capsulotomy). Several authors have proposed solutions techniques to limit the occurrence of this contract: – place the implant behind the muscle pectoral – manufacture of rough walls on the outside of the implant (prosthesis textured) – the use of physiological saline filled implants.
- Rupture and deflation. This type of accidents occur due to an alteration in the lining of the prosthesis is the continent (silicone elastomer). The phenomenon of porosity, or the opening or punctiform a real gap may be the cause and appear as a result of trauma violent, a manufacturing defect, but mostly due to the age of the prosthesis (effect of use). Deflation in saline containing prostheses may be a problem lost by the filling valve. This type prosthesis has a total or partial deflated quickly. if a prosthesis is filled with silicone gel, the gel remains in the fibrous coating surrounding the implant (intracapsular leak). The flight then has no clinical significance. However, intracapsular exudate can favor the appearance of a capsule periprotética. Less often, if significant gap in relation to trauma violent or a needle, the gel escapes beyond the fibrous capsule (break extracapsular). In small amounts, the gel can cause the appearance of a granuloma or body strange in the form of nodules (siliconoma). In case of rupture important capsular (trauma), the gel diffuses into surrounding tissue, breast, making a very soft consistency, and inflammatory reactions may occur: in these cases the surgical implant is necessary.