Tuberous Breast, Deformities and Asymmetries: A Retrospective Analysis Comparing Fat Grafting Versus Mastopexy and Breast Implants

ead with great interest the article titled: ‘‘Tuberous Breast, Deformities and asymmetries: a retrospective analysis comparing fat grafting versus mastopexy and breast implants” by Pietro Gentile [1]. Tuberous breast deformity is a congenital malformation appearing with a wide spectrum of anatomical presentations that can also appear in male subjects suffering from gynecomastia [2, 3]. For these reasons it poses a real challenge to surgical correction and usually the simple introduction of a breast implant, as well as adipose tissue remodeling, does not always allow satisfactory outcomes [2,3,4,5,6,7,8,9,10]. In this interesting paper the Author compares results obtained in patients suffering from Tuberous Breast, deformities and asymmetries treated with fat grafting with those of patients underwent mastopexy and breast implant. A careful analysis of the influence of breast and chest deformities is also considered in the text. Since fat grafting consists in a purely autologous and natural reconstructive method, we totally agree with the author that the procedure could be an effective technique in tuberous breast correction and breast deformities recontouring, because of the natural appearance and consistency of the final outcomes. However, we have some elements to discuss. Even if autologous fat grafting could represent a major tool, multiple surgical steps are required and therefore it could represent a discomfort for patients, including emotional distress and adjunctive financial costs. Moreover, a suitable fat donor site is essential for both quantity and quality, and this condition is not always present. Showing very excellent results in a significant cohort of patients, the Author performed implanting linear deposits of adipose tissue in multiple layers including intra-glandular area. Among the complications, the incidence of 14% of oil cysts and post-operative calcifications were reported. Although nowadays fat grafting appears to be a safe procedure, another scenario of interest concerns the safety of Adipose Derived Stem Cells in breast surgery. Although some clinical 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. Moreover, post-operative intra-parenchymal calcifications could sensitively interfere with the long lasting screening of breast cancer and therefore intra-glandular fat grafting should be carefully considered, particularly in young patients [11, 12]. Although good aesthetic results have been reported, the oncologic safety of the procedure remains under investigation and therefore intra parenchymal fat grafting should be carefully used [13].