The authors, from Indiana University, provide a 20-year retrospective review of 66 patients with congenital and acquired breast anomalies treated in an academic practice in Indianapolis. Based on their review, a classification system for both congenital and acquired anomalies is presented, which provides the basis for categorizing treatment options and outcomes. Hyperplastic abnormalities were classified in 44 patients (mean age at initial operation 17.4 years) and included gynecomastia, hyperplasia, polythelia (the presences of supernumerary nipples), polymastia, and giant fibroadenoma. Deformational abnormalities were divided into iatrogenic or traumatic; there were 11 patients in this category (mean age at initial operation 18.5 years). Hypoplastic abnormalities included athelia (absence of the nipple), hypoplasia, tuberous breast, and Poland syndrome (11 patients, mean age at initial operation 18.1 years).
Gynecomastia (46%) and juvenile hypertrophy (32%) accounted for the majority of the hyperplasia patients. Gynecomastia treatment currently consists of a combination of glandular excision and ultrasonic liposuction depending on the degree of enlargement, with an average age at treatment of 15.5 years. Patients with juvenile hypertrophy were treated after puberty with volume reduction, correction of breast asymmetry, and nipple-areola repositioning as needed. Females with giant fibroadenomas may present with dramatic growth of the benign lesion with normal gonadal hormone levels. Patients with polythelia may have urologic anomalies. If these accessory nipples are pigmented, they should be removed by elliptical excision before puberty since cancerous degeneration has been reported.1 In cases of deformational breast problems, etiologies included previous thoracotomy, thermal injury, and hemangioma near the breast bud. Corrective procedures included scar revision, implant placement, skin grafting, and nipple-areola complex reconstruction. Hypoplastic abnormalities included Poland syndrome, athelia, amastia, and tuberous breast deformities. Amastia and Poland syndrome may represent congenital ectodermal defects.2 Hypoplastic deformities such as Poland syndrome may have underlying chest wall deformities such as absent ribs, pectoralis muscles, and subcutaneous fat; brachydactyly or syndactyly may also occur. Reconstruction may require muscle flaps as well as implants.
Dr. Burstein has disclosed no financial relationships relevant to this commentary.
Breast deformities are commonly seen in the pediatrician’s office in both male and female patients. There are many social and psychological issues that can result from these deformities. These authors provide a very simple and practical classification system that allows for logical therapeutic decisions. Of particular interest were the associated conditions and underlying anomalies that can accompany breast deformities. The authors’ treatment consists of various surgical techniques depending on the specific anomaly. These include reduction mammaplasty in hyperplasia, modified mastectomy for breast duplication, ultrasonic liposuction for gynecomastia, muscle flap chest wall reconstruction in Poland syndrome, and excision of accessory nipples in polythelia.