An algorithm for the management of tuberous breast deformity

Andrej Salibi, Sunil S. Thomas


Background: There are various categories in the surgical management of tubular/tuberous breast deformity (TBD) that are focused on the laterality [unilateral (U/L) vs. bilateral (B/L)] and the severity of the deformity (grades I to IV). This study reviewed the management of this deformity and found that ‘grade’ and ‘laterality’ to be two important clinical factors in planning a single stage or two-stage procedures.
Methods: Outcome evaluation included patient satisfaction following either a single stage or two-stage procedures, which was reassessed over an average period of five years. A number of pre- and post-operative clinical and subjective evaluation criteria, in addition to von Heimburg’s classification were used to assess the grade (severity) of the deformity. Patients were divided into two main groups according to their grades of deformity.
Results: Nearly two thirds (60%) of the deformities were unilateral. A total of 95% of patients with lower grades required a single-stage procedure and 50% in the higher grades group. 91% in the lower grades group had implants only. Tissue expansion (TE) followed by implants was the predominant operation in the higher grades group. There was no statistical significance in the patient satisfaction between the two groups. Mean satisfaction score was unchanged after 5 years. Revision rate was nearly two times more in the higher grades patients, and three times more common for the unilateral deformities.
Conclusions: The above findings demonstrate that TBD is a difficult clinical problem. The proposed algorithm can serve as a guide to establish a treatment pathway that facilitates better planning and management of this complex deformity.