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

Dear Sir, We read with great interest the article titled: ‘‘Stenotic breast malformation and its reconstructive surgical correction: a new concept from minor deformity to tuberous breast’’ by Klinger et al [1]. Tuberous breast is a rare congenital breast deformity appearing during puberty [2, 3]. It appears in different and extremely polymorphous clinical aspects consisting in various degrees of a single pathological entity, and the minor forms are not always easy to recognize. The authors proposed an interesting classification for tuberous breast malformation including all the minor forms of the deformities based on three main clinical parameters: type of stenosis, glandular trophism and ptosis. Introducing the concept of stenotic breast, the authors proposed an appropriate surgical strategy to correct each type of malformation and, considering all the anatomical features, described eight different categories of stenotic breasts. To date, classifications reported in the literature are based mainly on the localization of defect, excluding the minor form. We totally agree with the authors that an ideal classification must include all the types of tuberous breasts, taking also into account the quality, the quantity and the consistency of the parenchyma to suggest the most appropriate surgical planning. All these clinical features are not only theoretical, but represent essential elements that must be evaluated preoperatively. Besides the localization of the defect, the volume, the quality and the consistency of the parenchyma must be considered. In cases of low quantities of parenchyma, a breast implant can adjust the hypotrophic volume. Ptosis, if present, can be correct with a mastopexy, and the consistency of the skin envelope can be improved by lipofilling. We believe that the evaluation of the breast consistence is mandatory and cannot be underestimated or missed in a complete classification scheme. An exhaustive classification system must include all the clinical elements to identify immediately the correct diagnosis and the consequent surgical correction [4, 5]. However, we maintain that meticulous consideration at the inframammary fold is mandatory during tuberous breast correction because it is the real stigmata of the deformity. It also represents the main clinical feature that distinguishes simple ptosis of the breast from actual tuberous breast.