Tuberous Breast: A Wide Spectrum of Features of the Same Disorder—13-Year Experience-Based Classification and Reconstructive Algorithm

Background: A multitude of variants of tuberous breast exist, and a reconstructive algorithm could help in assessment of all features that affect the breast and planning the most appropriate surgical correction strategy. Although several efficient techniques have been described in the literature, the authors propose their experience to help standardize a diagnostic and therapeutic approach. The aim of this article is to assess the pathologic hallmarks of each type of tuberous breast and to propose a one-step reconstructive algorithm tailored to the patient characteristics based on the use of three different adipo-glandular flaps. Methods: From September of 2006 to December of 2019, 118 patients were treated for tuberous breast in a one-step procedure using tailored local flaps according to the preoperatively assessed clinical variant. Minimum follow-up was 12 months. All the procedures were performed under local anesthesia. Results: A total of 220 tuberous breasts (98 hypoplastic and 122 normoplastic) were treated. Mean patient age was 20.2 years. Mean follow-up was 36.5 months. Six minor complications (capsular contracture and nipple-areola complex hypesthesia) but no major complications were reported. In 9% of cases, minor secondary procedures, including lipofilling, scar revisions, and breast implant substitution, were performed. Conclusion: The proposed algorithm, including a comprehensive classification, preoperative planning, and surgical approach derived from the authors' experience, presents a tailored surgical approach for each type of tuberous breast. Clinical question/level of evidence: Therapeutic, IV.