Stenotic Breast Malformation and Its Reconstructive Surgical Correction: A New Concept From Minor Deformity to Tuberous Breast

M. Klinger, F. Klinger, S. Giannasi, A. Veronesi, V. Bandi, B. Banzatti, B. Catania, V. Vinci, A. Lisa, G. Cornegliani, M. Giaccone, F. Caviggioli, L. Maione

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Several classification systems have been reported to define the spectrum of tuberous breast deformity, and a range of surgical techniques has been described. In this paper, we proposed a new classification including tuberous breast and minor deformity based on stenosis type, glandular trophism and ptosis adapting surgical planning to different breast types. Methods: A total of 246 patients meeting our definition for stenotic breasts asking for surgery were analyzed in this study. We considered eight different types of stenotic breasts analyzing anatomical presentations, and we then proposed eight key-point maneuvers, finalized to the correction of different breast deformities and their possible association according to the stenotic breast type. Results have been evaluated by a group of three surgeons and by patients. In addition, we evaluated the complication incidence in terms of re-intervention rate. Results: Following our classification eight different groups were distinguished. For each one we reported the prevalence and the surgical procedure adopted. Results evaluated by the surgeon group reported a mean aesthetic outcome of 8.2 (range 5–10), whereas patients reported a mean value of 7.9 (range 6–10). During a follow-up period with a mean of 16 months we observed a 4.9% re-intervention rate. Conclusions: We believe this new classification to be very complete in evaluating breast shape, including most of the breast evaluable features. Our results confirmed the suitability of the approach for appropriate preoperative planning, thus improving the global surgical outcome. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. © 2017, Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.
Original languageEnglish
Pages (from-to)1068-1077
Number of pages10
JournalAesthetic Plastic Surgery
Volume41
Issue number5
DOIs
Publication statusPublished - 2017

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Breast
Plastic Surgery
Evidence-Based Medicine
Esthetics
Pathologic Constriction
Incidence

Keywords

  • Breast
  • Classification
  • Stenotic
  • Surgery

Cite this

Stenotic Breast Malformation and Its Reconstructive Surgical Correction: A New Concept From Minor Deformity to Tuberous Breast. / Klinger, M.; Klinger, F.; Giannasi, S.; Veronesi, A.; Bandi, V.; Banzatti, B.; Catania, B.; Vinci, V.; Lisa, A.; Cornegliani, G.; Giaccone, M.; Caviggioli, F.; Maione, L.

In: Aesthetic Plastic Surgery, Vol. 41, No. 5, 2017, p. 1068-1077.

Research output: Contribution to journalArticle

Klinger, M. ; Klinger, F. ; Giannasi, S. ; Veronesi, A. ; Bandi, V. ; Banzatti, B. ; Catania, B. ; Vinci, V. ; Lisa, A. ; Cornegliani, G. ; Giaccone, M. ; Caviggioli, F. ; Maione, L. / Stenotic Breast Malformation and Its Reconstructive Surgical Correction: A New Concept From Minor Deformity to Tuberous Breast. In: Aesthetic Plastic Surgery. 2017 ; Vol. 41, No. 5. pp. 1068-1077.
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title = "Stenotic Breast Malformation and Its Reconstructive Surgical Correction: A New Concept From Minor Deformity to Tuberous Breast",
abstract = "Background: Several classification systems have been reported to define the spectrum of tuberous breast deformity, and a range of surgical techniques has been described. In this paper, we proposed a new classification including tuberous breast and minor deformity based on stenosis type, glandular trophism and ptosis adapting surgical planning to different breast types. Methods: A total of 246 patients meeting our definition for stenotic breasts asking for surgery were analyzed in this study. We considered eight different types of stenotic breasts analyzing anatomical presentations, and we then proposed eight key-point maneuvers, finalized to the correction of different breast deformities and their possible association according to the stenotic breast type. Results have been evaluated by a group of three surgeons and by patients. In addition, we evaluated the complication incidence in terms of re-intervention rate. Results: Following our classification eight different groups were distinguished. For each one we reported the prevalence and the surgical procedure adopted. Results evaluated by the surgeon group reported a mean aesthetic outcome of 8.2 (range 5–10), whereas patients reported a mean value of 7.9 (range 6–10). During a follow-up period with a mean of 16 months we observed a 4.9{\%} re-intervention rate. Conclusions: We believe this new classification to be very complete in evaluating breast shape, including most of the breast evaluable features. Our results confirmed the suitability of the approach for appropriate preoperative planning, thus improving the global surgical outcome. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. {\circledC} 2017, Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.",
keywords = "Breast, Classification, Stenotic, Surgery",
author = "M. Klinger and F. Klinger and S. Giannasi and A. Veronesi and V. Bandi and B. Banzatti and B. Catania and V. Vinci and A. Lisa and G. Cornegliani and M. Giaccone and F. Caviggioli and L. Maione",
note = "Export Date: 2 March 2018 CODEN: APSUD Correspondence Address: Klinger, M.; Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, Italy; email: marco.klinger@humanitas.it References: Mandrekas, A.D., Zambacos, G.J., Anastasopoulos, A., Hapsas, D., Lambrinaki, N., Ioannidou-Mouzaka, L., Aesthetic reconstruction of the tuberous breast deformity (2003) Plast Reconstr Surg, 112, pp. 1099-1108. , PID: 12973230, Discussion 1109; Grolleau, J.L., Pienkowski, C., Chavoin, J.P., Costagliola, M., Rochiccioli, P., Morphological anomalies of breasts in adolescent girls and their surgical correction (1997) Arch Pediatr, 4 (12), pp. 1182-1191. , COI: 1:STN:280:DyaK1c7pvFahsw{\%}3D{\%}3D, PID: 9538420; Klinger, M., Caviggioli, F., Klinger, F., Villani, F., Arra, E., Di Tommaso, L., Tuberous breast: morphological study and overview of a borderline entity (2011) Can J Plast Surg, 19 (2), pp. 42-44. , PID: 22654530; Klinger, M., Caviggioli, F., Giannasi, S., Bandi, V., Banzatti, B., Veronesi, A., Barbera, F., Klinger, F., The prevalence of tuberous/constricted breast deformity in population and in breast augmentation and reduction mammaplasty patients (2016) Aesthetic Plast Surg, 40 (4), pp. 492-496. , PID: 27271839; Caviggioli, F., Forcellini, D., Vinci, V., Cornegliani, G., Klinger, F., Klinger, M., Employment of needles: a different technique for fat placement (2012) Plast Reconstr Surg, 130 (2), pp. 373e-374e. , COI: 1:CAS:528:DC{\%}2BC38XhtFSisbbE, PID: 22842444; Norman, G., Likert scales, levels of measurement and the “laws” of statistics (2010) Adv Health Sci Educ Theory Pract, 15, pp. 625-632. , PID: 20146096; Chiu, C.H., Correction with autologous fat grafting for contour changes of the breasts after implant removal in Asian women (2016) J Plast Reconstr Aesthet Surg, 69 (1), pp. 61-69. , PID: 26441198; Rees, T.D., Aston, S.J., The tuberous breast (1976) Clin Plast Surg, 3 (2), pp. 339-347. , COI: 1:STN:280:DyaE287msVahsA{\%}3D{\%}3D, PID: 1261187; Dinner, M.I., Dowden, R.V., The tubular/tuberous breast syndrome (1987) Ann Plast Surg, 19 (5), pp. 414-420. , COI: 1:STN:280:DyaL1c{\%}2FnsFOntA{\%}3D{\%}3D, PID: 3688788; Bass, C.B., Herniated areolar complex (1978) Ann Plast Surg, 1 (4), pp. 402-406. , COI: 1:STN:280:DyaE1M{\%}2FotFWjtA{\%}3D{\%}3D, PID: 727676; Tebbetts, J.B., Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types (2001) Plast Reconstr Surg, 107 (5), pp. 1255-1272. , COI: 1:STN:280:DC{\%}2BD3M3oslelsA{\%}3D{\%}3D, PID: 11373572; Brink, R.R., Evaluating breast parenchymal maldistribution with regard to mastopexy and augmentation mammaplasty (1990) Plast Reconstr Surg, 86 (4), pp. 715-719. , COI: 1:STN:280:DyaK3M{\%}2FhvVSmug{\%}3D{\%}3D, PID: 2217587; Gruber, R.P., Jones, H.W., Jr., The “donut” mastopexy: indications and complications (1980) Plast Reconstr Surg, 65 (1), pp. 34-38. , COI: 1:STN:280:DyaL3c{\%}2FotVeksQ{\%}3D{\%}3D, PID: 7350575; DeLuca-Pytell, D.M., Piazza, R.C., Holding, J.C., Snyder, N., Hunsicker, L.M., Phillips, L.G., The incidence of tuberous breast deformity in asymmetric and symmetric mammaplasty patients (2005) Plast Reconstr Surg, 116 (7), pp. 1894-1899. , COI: 1:CAS:528:DC{\%}2BD2sXkt1OmtQ{\%}3D{\%}3D, PID: 16327600; Von Heimburg, D., Exner, K., Kruft, S., Lemperle, G., The tuberous breast deformity: classification and treatment (1996) Br J Plast Surg, 49 (6), pp. 339-345; Grolleau, J.L., Lanfrey, E., Lavigne, B., Chavoin, J.P., Costagliola, M., Breast base anomalies: treatment strategy for tuberous breasts, minor deformities, and asymmetry (1999) Plast Reconstr Surg, 104 (7), pp. 2040-2048. , COI: 1:STN:280:DC{\%}2BD3M{\%}2FptlWhtw{\%}3D{\%}3D, PID: 11149766; Meara, J.G., Kolker, A., Bartlett, G., Theile, R., Mutimer, K., Holmes, A.D., Tuberous breast deformity: principles and practice (2000) Ann Plast Surg, 45 (6), pp. 607-611. , COI: 1:STN:280:DC{\%}2BD3M{\%}2Fps1Cksw{\%}3D{\%}3D, PID: 11128758; Muti, E., Personal approach to surgical correction of the extremely hypoplastic tuberous breast (1996) Aesthetic Plast Surg, 20 (5), pp. 385-390. , COI: 1:STN:280:DyaK2s{\%}2Fgt1Cjuw{\%}3D{\%}3D, PID: 8849429; Costagliola, M., Atiyeh, B., Rampillon, F., Tuberous breast: revised classification and a new hypothesis for its development (2013) Aesthetic Plast Surg, 37 (5), pp. 896-903. , PID: 23636134; Delay, E., Sinna, R., Ho Quoc, C., Tuberous breast correction by fat grafting (2013) Aesthet Surg J, 33 (4), pp. 522-528. , PID: 23636625; Panchapakesan, V., Brown, M.H., Management of tuberous breast deformity with anatomic cohesive silicone gel breast implants (2009) Aesthetic Plast Surg, 33 (1), pp. 49-53. , PID: 18752021; Kolker, A.R., Collins, M.S., Tuberous breast deformity: classification and treatment strategy for improving consistency in aesthetic correction (2015) Plast Reconstr Surg, 135 (1), pp. 73-86. , COI: 1:CAS:528:DC{\%}2BC2cXitFeitbjN, PID: 25539297; Klinger, M., Marazzi, M., Vigo, D., Fat Injection for cases of severe burn outcomes: a new perspective of scar remodeling and reduction (2008) Aesth Plast Surg, 32, pp. 465-469. , COI: 1:STN:280:DC{\%}2BD1czkvVCitA{\%}3D{\%}3D; Klinger, M., Caviggioli, F., Klinger, F.M., Giannasi, S., Bandi, V., Banzatti, B., Forcellini, D., Vinci, V., Autologous fat graft in scar treatment (2013) J Craniofac Surg, 24 (5), pp. 1610-1615. , PID: 24036737; Klinger, M., Giannasi, S., Klinger, F., Caviggioli, F., Bandi, V., Banzatti, B., Forcellini, D., Tinterri, C., Periareolar approach in oncoplastic breast conservative surgery (2016) Breast J, , PID: 27088898",
year = "2017",
doi = "10.1007/s00266-017-0903-2",
language = "English",
volume = "41",
pages = "1068--1077",
journal = "Aesthetic Plastic Surgery",
issn = "0364-216X",
publisher = "Springer New York LLC",
number = "5",

}

TY - JOUR

T1 - Stenotic Breast Malformation and Its Reconstructive Surgical Correction: A New Concept From Minor Deformity to Tuberous Breast

AU - Klinger, M.

AU - Klinger, F.

AU - Giannasi, S.

AU - Veronesi, A.

AU - Bandi, V.

AU - Banzatti, B.

AU - Catania, B.

AU - Vinci, V.

AU - Lisa, A.

AU - Cornegliani, G.

AU - Giaccone, M.

AU - Caviggioli, F.

AU - Maione, L.

N1 - Export Date: 2 March 2018 CODEN: APSUD Correspondence Address: Klinger, M.; Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, Italy; email: marco.klinger@humanitas.it References: Mandrekas, A.D., Zambacos, G.J., Anastasopoulos, A., Hapsas, D., Lambrinaki, N., Ioannidou-Mouzaka, L., Aesthetic reconstruction of the tuberous breast deformity (2003) Plast Reconstr Surg, 112, pp. 1099-1108. , PID: 12973230, Discussion 1109; Grolleau, J.L., Pienkowski, C., Chavoin, J.P., Costagliola, M., Rochiccioli, P., Morphological anomalies of breasts in adolescent girls and their surgical correction (1997) Arch Pediatr, 4 (12), pp. 1182-1191. , COI: 1:STN:280:DyaK1c7pvFahsw%3D%3D, PID: 9538420; Klinger, M., Caviggioli, F., Klinger, F., Villani, F., Arra, E., Di Tommaso, L., Tuberous breast: morphological study and overview of a borderline entity (2011) Can J Plast Surg, 19 (2), pp. 42-44. , PID: 22654530; Klinger, M., Caviggioli, F., Giannasi, S., Bandi, V., Banzatti, B., Veronesi, A., Barbera, F., Klinger, F., The prevalence of tuberous/constricted breast deformity in population and in breast augmentation and reduction mammaplasty patients (2016) Aesthetic Plast Surg, 40 (4), pp. 492-496. , PID: 27271839; Caviggioli, F., Forcellini, D., Vinci, V., Cornegliani, G., Klinger, F., Klinger, M., Employment of needles: a different technique for fat placement (2012) Plast Reconstr Surg, 130 (2), pp. 373e-374e. , COI: 1:CAS:528:DC%2BC38XhtFSisbbE, PID: 22842444; Norman, G., Likert scales, levels of measurement and the “laws” of statistics (2010) Adv Health Sci Educ Theory Pract, 15, pp. 625-632. , PID: 20146096; Chiu, C.H., Correction with autologous fat grafting for contour changes of the breasts after implant removal in Asian women (2016) J Plast Reconstr Aesthet Surg, 69 (1), pp. 61-69. , PID: 26441198; Rees, T.D., Aston, S.J., The tuberous breast (1976) Clin Plast Surg, 3 (2), pp. 339-347. , COI: 1:STN:280:DyaE287msVahsA%3D%3D, PID: 1261187; Dinner, M.I., Dowden, R.V., The tubular/tuberous breast syndrome (1987) Ann Plast Surg, 19 (5), pp. 414-420. , COI: 1:STN:280:DyaL1c%2FnsFOntA%3D%3D, PID: 3688788; Bass, C.B., Herniated areolar complex (1978) Ann Plast Surg, 1 (4), pp. 402-406. , COI: 1:STN:280:DyaE1M%2FotFWjtA%3D%3D, PID: 727676; Tebbetts, J.B., Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types (2001) Plast Reconstr Surg, 107 (5), pp. 1255-1272. , COI: 1:STN:280:DC%2BD3M3oslelsA%3D%3D, PID: 11373572; Brink, R.R., Evaluating breast parenchymal maldistribution with regard to mastopexy and augmentation mammaplasty (1990) Plast Reconstr Surg, 86 (4), pp. 715-719. , COI: 1:STN:280:DyaK3M%2FhvVSmug%3D%3D, PID: 2217587; Gruber, R.P., Jones, H.W., Jr., The “donut” mastopexy: indications and complications (1980) Plast Reconstr Surg, 65 (1), pp. 34-38. , COI: 1:STN:280:DyaL3c%2FotVeksQ%3D%3D, PID: 7350575; DeLuca-Pytell, D.M., Piazza, R.C., Holding, J.C., Snyder, N., Hunsicker, L.M., Phillips, L.G., The incidence of tuberous breast deformity in asymmetric and symmetric mammaplasty patients (2005) Plast Reconstr Surg, 116 (7), pp. 1894-1899. , COI: 1:CAS:528:DC%2BD2sXkt1OmtQ%3D%3D, PID: 16327600; Von Heimburg, D., Exner, K., Kruft, S., Lemperle, G., The tuberous breast deformity: classification and treatment (1996) Br J Plast Surg, 49 (6), pp. 339-345; Grolleau, J.L., Lanfrey, E., Lavigne, B., Chavoin, J.P., Costagliola, M., Breast base anomalies: treatment strategy for tuberous breasts, minor deformities, and asymmetry (1999) Plast Reconstr Surg, 104 (7), pp. 2040-2048. , COI: 1:STN:280:DC%2BD3M%2FptlWhtw%3D%3D, PID: 11149766; Meara, J.G., Kolker, A., Bartlett, G., Theile, R., Mutimer, K., Holmes, A.D., Tuberous breast deformity: principles and practice (2000) Ann Plast Surg, 45 (6), pp. 607-611. , COI: 1:STN:280:DC%2BD3M%2Fps1Cksw%3D%3D, PID: 11128758; Muti, E., Personal approach to surgical correction of the extremely hypoplastic tuberous breast (1996) Aesthetic Plast Surg, 20 (5), pp. 385-390. , COI: 1:STN:280:DyaK2s%2Fgt1Cjuw%3D%3D, PID: 8849429; Costagliola, M., Atiyeh, B., Rampillon, F., Tuberous breast: revised classification and a new hypothesis for its development (2013) Aesthetic Plast Surg, 37 (5), pp. 896-903. , PID: 23636134; Delay, E., Sinna, R., Ho Quoc, C., Tuberous breast correction by fat grafting (2013) Aesthet Surg J, 33 (4), pp. 522-528. , PID: 23636625; Panchapakesan, V., Brown, M.H., Management of tuberous breast deformity with anatomic cohesive silicone gel breast implants (2009) Aesthetic Plast Surg, 33 (1), pp. 49-53. , PID: 18752021; Kolker, A.R., Collins, M.S., Tuberous breast deformity: classification and treatment strategy for improving consistency in aesthetic correction (2015) Plast Reconstr Surg, 135 (1), pp. 73-86. , COI: 1:CAS:528:DC%2BC2cXitFeitbjN, PID: 25539297; Klinger, M., Marazzi, M., Vigo, D., Fat Injection for cases of severe burn outcomes: a new perspective of scar remodeling and reduction (2008) Aesth Plast Surg, 32, pp. 465-469. , COI: 1:STN:280:DC%2BD1czkvVCitA%3D%3D; Klinger, M., Caviggioli, F., Klinger, F.M., Giannasi, S., Bandi, V., Banzatti, B., Forcellini, D., Vinci, V., Autologous fat graft in scar treatment (2013) J Craniofac Surg, 24 (5), pp. 1610-1615. , PID: 24036737; Klinger, M., Giannasi, S., Klinger, F., Caviggioli, F., Bandi, V., Banzatti, B., Forcellini, D., Tinterri, C., Periareolar approach in oncoplastic breast conservative surgery (2016) Breast J, , PID: 27088898

PY - 2017

Y1 - 2017

N2 - Background: Several classification systems have been reported to define the spectrum of tuberous breast deformity, and a range of surgical techniques has been described. In this paper, we proposed a new classification including tuberous breast and minor deformity based on stenosis type, glandular trophism and ptosis adapting surgical planning to different breast types. Methods: A total of 246 patients meeting our definition for stenotic breasts asking for surgery were analyzed in this study. We considered eight different types of stenotic breasts analyzing anatomical presentations, and we then proposed eight key-point maneuvers, finalized to the correction of different breast deformities and their possible association according to the stenotic breast type. Results have been evaluated by a group of three surgeons and by patients. In addition, we evaluated the complication incidence in terms of re-intervention rate. Results: Following our classification eight different groups were distinguished. For each one we reported the prevalence and the surgical procedure adopted. Results evaluated by the surgeon group reported a mean aesthetic outcome of 8.2 (range 5–10), whereas patients reported a mean value of 7.9 (range 6–10). During a follow-up period with a mean of 16 months we observed a 4.9% re-intervention rate. Conclusions: We believe this new classification to be very complete in evaluating breast shape, including most of the breast evaluable features. Our results confirmed the suitability of the approach for appropriate preoperative planning, thus improving the global surgical outcome. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. © 2017, Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.

AB - Background: Several classification systems have been reported to define the spectrum of tuberous breast deformity, and a range of surgical techniques has been described. In this paper, we proposed a new classification including tuberous breast and minor deformity based on stenosis type, glandular trophism and ptosis adapting surgical planning to different breast types. Methods: A total of 246 patients meeting our definition for stenotic breasts asking for surgery were analyzed in this study. We considered eight different types of stenotic breasts analyzing anatomical presentations, and we then proposed eight key-point maneuvers, finalized to the correction of different breast deformities and their possible association according to the stenotic breast type. Results have been evaluated by a group of three surgeons and by patients. In addition, we evaluated the complication incidence in terms of re-intervention rate. Results: Following our classification eight different groups were distinguished. For each one we reported the prevalence and the surgical procedure adopted. Results evaluated by the surgeon group reported a mean aesthetic outcome of 8.2 (range 5–10), whereas patients reported a mean value of 7.9 (range 6–10). During a follow-up period with a mean of 16 months we observed a 4.9% re-intervention rate. Conclusions: We believe this new classification to be very complete in evaluating breast shape, including most of the breast evaluable features. Our results confirmed the suitability of the approach for appropriate preoperative planning, thus improving the global surgical outcome. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. © 2017, Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.

KW - Breast

KW - Classification

KW - Stenotic

KW - Surgery

U2 - 10.1007/s00266-017-0903-2

DO - 10.1007/s00266-017-0903-2

M3 - Article

VL - 41

SP - 1068

EP - 1077

JO - Aesthetic Plastic Surgery

JF - Aesthetic Plastic Surgery

SN - 0364-216X

IS - 5

ER -