Circumlateral Vertical Augmentation Mastopexy for the Correction of Ptosis and Hypoplasia of the Lower Medial Quadrant in Tuberous Breast Deformity

Dear Sir, We read with great interest the article titled: ‘‘Circumlateral Vertical Augmentation Mastopexy for the Correction of Ptosis and Hypoplasia of the Lower Medial Quadrant in Tuberous Breast Deformity’’ by Vitaly Zholtikov et al. [1]. The authors propose their experiences in tuberous breast correction with a large number of cases, showing very good results. Tuberous breast (TB) is a congenital deformity that can appear in different and extremely polymorphous clinical aspects, consisting in various degrees of a single pathological entity including anatomical location of the defect, volume, asymmetry, quality and consistency of the tissue [2]. We believe that only a topographic consideration of the malformation is insufficient to plan an adequate surgical strategy to correct each type of malformation. Beside the localization of the defect, the volume, the quality and the consistency of the parenchyma are essential elements and they must be considered [3]. According to the Grolleau classification, the cohort of patients included in the present paper belong to type I, consisting of parenchymal deficiency of the medial inferior quadrant. We completely agree with the authors regarding the use of local flaps to fulfil the missing quadrant to achieve a pleasant aesthetical appearance of the new mammary cone, but we have some elements to discuss. In the presence of a very short distance between the inferior edge of the areola and the inframammary fold (as shown in Fig. 4 by the authors), the upper pole of the breast generally shows a full appearance because most the parenchyma is displaced upwards. This extra parenchyma could be used as a flap to increase the deficiency of thickness in the deficient quadrant thus to avoid extra areola scarring. The use of flaps, harvested from the extra parenchyma, rebalance the difference in volume between the upper and the lower pole, transferring the excess of breast tissue to the deficient pole, and could be harvested with a single minimal incision at the border of the areola [4]. In presented cases, the minimal breast ptosis could be easily corrected with a combination of type III Dual Plane technique and glandular flaps [5]. Furthermore, this deformity is generally unilateral, associated with a hypoplastic TB on the contralateral side, showing an evident asymmetry. In the presence of asymmetry, we maintain that volume assessment could be performed by reducing the bigger breast with the aim to reduce the difference in size of the breast implant to obtain more stable long-lasting results [6]. Compliance with Ethical Standards