Discussion: Management of Tuberous Breast Deformities: Review of Long-Term Outcomes and Patient Satisfaction with BREAST-Q

Sir, We read with great interest entitled ‘‘Management of Tuberous Breast Deformities: Review of Long-term Outcomes and Patient Satisfaction with BREAST-Q’’ by Tenna S et al. [1]. We congratulate the authors for the results shown. The tuberous breast (TB) represents one of the most frequent malformations of the thoraco-mammary region, and, like for other syndromes, different treatments have been proposed [2]. As described by the authors, according to the present literature, currently the most used surgical procedures, for the treatment of this condition, are represented by the use of prostheses and/or adipose-glandular flaps and autologous fat [3]. The authors compared the two methods described above, analyzing complications, need for multiple surgical procedures and also patients’ satisfaction rate. The analysis conducted on the data by the authors shows a greater complication rate in surgical correction with the use of breast implants compared to lipofilling procedures. We agree with the authors in affirming what was stated for which it would be an appropriate decision algorithm that takes into account these data. For similar cases, we proposed a new classification of the tuberous breast, according to the experience of the senior author (A. Innocenti). Following review of the literature and according to personal experiences, the authors proposed a new classification including the minor forms, considering, besides the anatomical location of the defect, the breast volume and tissue quality [4]. Based on the volume, we identified hypoplastic and normoplastic TB. Basing on the consistency of the tissue, the former can be distinguished in soft and solid TB. The soft hypoplastic TB, hanging from the thorax by a very constricted mammary base, represents the most severe form of the deformity. Its skin cover, consisting almost entirely of the wide areola, is extremely thin and easily pinched in folds because of the poor presence of suspending ligaments. On the contrary, solid hypoplastic TB has a wider mammary base, a smaller areola and a thicker skin cover firmly connected to the parenchyma through compact connections by Cooper ligaments. The inferior mammary pole is generally flat or concave, whereas the inframammary fold is absent. The extreme polymorphism of the TB appearance requires careful identification and classification to define an appropriate surgical plan. The classification of TB deformity and the surgical treatment that we are proposing allow both better understanding and treatment of the malformation related to the wide morphological range of the malformation including minor forms that, however, represent real clinical entities. The aim of this ‘‘discussion’’ is to bring to the attention of the authors our personal classification system and, hopefully, start a comparison. Further studies need to be conducted to improve the outcomes, classification and treatment of TB.