Autologous Fat Grafting with Percutaneous Fasciotomy and Reduction of the Nipple–Areolar Complex for the Correction of Tuberous Breast Deformity in Teenagers

Dear Sir, We read with great interest the article titled: ‘‘Autologous Fat Grafting with Percutaneous Fasciotomy and Reduction of the Nipple–Areolar Complex for the Correction of Tuberous Breast Deformity in Teenagers’’ by Patricia Gutierrez-Ontalvilla et al. The authors described their experiences in tuberous breast correction and reported on nine teenagers who underwent surgical correction by percutaneous fasciotomies and fat grafting. We totally agree with the authors that fat grafting could be an effective method in tuberous breast, but we have something to discuss. Since the variability of fat graft survival is unpredictable, the need for multiple sections is often mandatory to obtain a satisfactory correction of the disorder. This could represent a discomfort for patients, including emotional distress and adjunctive financial costs. Furthermore, we retain that the risk for asymmetrical results, due to the variable engraftment, could be higher compared to the combined use of breast implants and glandular flaps. The risk of implant displacement, including rotation of the anatomical prosthesis, is reduced with the use of round implants. Recently, we published a paper reporting our personal experience in tuberous breast correction using smooth round implants. Covering the upper part of the implant with the muscle, an optimal soft tissue coverage of the upper part of the prosthesis even in thin patients is obtained. The pressure of the muscle on the top of the implant makes the soft gel inside the implant very similar to the anatomical shape, avoiding the visibility of the upper edge of the implant even in very thin patients and, at the same time, any constrictions of the lower part of the implant by the muscle itself allow the full expansion of the constricted area of the breast. Regarding the natural aspect of the final result, in our personal opinion, the real difference between anatomical and round implant is very evident only in the presence of big implants and their use is, in general, out of order during tuberous breast correction [1–5]. The authors performed fat grafting in multiple layers from the deep zone to the surface, beginning above the pectoralis major muscle up to the subcutaneous tissue; it means that fat is directly injected also in breast parenchyma. Although fat grafting appears to be a safe procedure, another scenario of interest concerns the safety of adipose-derived stem cells in breast augmentation, especially in young patients. Intraparenchymal infiltration of adipose-derived stem cells could represent a potential risk for some patients including the younger. Did the authors collect medical histories focusing on familiarity of breast cancer before proposing this type of surgical procedure? Were patients with oncological familiarity excluded from the study? Although some clinical case series and trials trend to support the safety of the use of fat graft in the & breast tissue, the propensity of adipose-derived stem cells in promoting the growth of de novo breast cancer is still very debated in the actual scientific literature.