Principles of surgical treatment of congenital, developmental and acquired female breast asymmetries

Abstract

Background/Aim. There is a natural asymmetry in normal female brests. When the difference in the shape, size or position of the breast and nipple-areola complex is visible, surgical correction is the only treatment option and presents one of the greatest challenges for a plastic surgeon. Based on the Nahai classification presented in details, the aim of the study was to present the possibilities of plastic surgery to correct primary (congenital), secondary (developmental) and tertiary (acquired) brest asymmetries. Methods. We conducted a retrospective analysis of female breast asymmetry surgeries performed in the Clinic for Plastic Surgery and Burns, Military Medical Academy (MMA), Belgrade over the last seven years (January 2002 - January 2009). Results. During the above mentioned period, 82 female patients, 18 - 65 years of age, underwent surgery for breast asymmetry. The most frequent asymmetries were developmental, 'pubertal' (n = 43); acquired asymmetries as a consequence of tumor surgery were found in the other 22 patients, while 7 patients were diagnosed with primary asymmetries such as congenital chest-wall asymmetry (Sy. Poland), accessory and tuberous breasts. All patients underwent preoperative ultrasound examination, while hormone status was determined in those with developmental, 'pubertal' asymmetries. The selection of surgical procedure for correction of breast asymmetry depended upon clinical examination findings and patient's wish relating to the shape and size of the breasts. The most of breast asymmetries were corrected by a combination of surgical procedures including primary and secondary reconstruction, reduction, suspension or augmentation mammoplasty. Having combined different surgical procedures, we managed to achieve satisfactory results. The hypertrophic scar formation after reduction mamoplasty was seen in some cases, however, they caused no significant patient's discomfort. Conclusion. Application of plastic, reconstructive and aesthetic surgical principles can considerably contribute to achieving excellent results in corrective surgery for breast asymmetries. In addition to most suitable breast asymmetry surgical procedures choice, motivation of a patient is also very important for achieving satisfactory results.Uvod/Cilj. Sve zenske dojke su prirodno asimetricne. Kada je razlika u obliku, velicini ili polozaju dojke i bradavice upadljiva, hirurska korekcija jedino je resenje i predstavlja jedan od najvecih izazova za hirurga plasticara. Pridrzavajuci se detaljno opisane klasifikacije po Nahaiju, cilj rada bio je da se prikazu mogucnosti plasticne hirurgije u resavanju primarnih (kongenitalnih), sekundarnih (razvojnih) i tercijarnih (stecenih) asimetrija dojke. Metode. Izvrsena je retrospektivna analiza hirurskih procedura za korekciju razlicitih vrsta asimetrija dojki kod zena koje su u poslednjih sedam godina koriscene u Klinici za plasticnu hirurgiju i opekotine VMA. Rezultati. Tokom poslednjih sedam godina u Klinici za plasticnu hirurgiju i opekotine VMA operisane su 82 bolesnice starosti od 18 do 65 godina. Najveci broj asimetrija bio je iz grupe razvojnih, 'pubertetskih asimetrija', cak 43. Operisano je sedam bolesnica sa primarnom asimetrijom: urodjena asimetrija grudnog kosa (Sy. Poland), prekobrojne i tuberozne dojke. Sve bolesnice bile su preoperativno ultrazvucno pregledane, a kod razvojnih asimetrija radjen je i hormonski status. Izbor hirurske tehnike za korekciju asimetrije diktirao je klinicki nalaz i zelja bolesnice za buducim izgledom dojki. Najveci broj asimetricnih dojki korigovan je primenom kombinovanih hirurskih procedura: primarna i sekundarna rekonstrukcija, redukciona, suspenziona ili augmentaciona mamoplastika. Kombinacijom hirurskih procedura postigli smo veoma zadovoljavajuce rezultate. Kod nekoliko bolesnica zabelezeni su hipertroficni postoperativni oziljci nakon redukcionih mamoplastika, koji nisu uzrokovali znacajne smetnje. Zakljucak. Primena principa plasticne, rekonstruktivne i estetske hirurgije moze znacajno da doprinese postizanju veoma dobrih rezultata u resavanju asimetrija dojki. Pored odgovarajuceg izbora operativnih procedura za resavanje asimetrije dojki, od izuzetnog znacaja je i motivisanost bolesnica za postizanje sto boljih rezultata.