Tubuläre Brustdeformität – Vorstellung eines etablierten Therapie-Algorithmus und Ergebnisse einer retrospektiven Untersuchung über 7 Jahre

Zusammenfassung

Hintergrund

Angeborene Fehlbildungen der weiblichen Brust stellen operativ eine besondere Herausforderung dar, die eine individuellen Therapie der jungen Patientinnen bedarf. In diesem Beitrag beschreiben wir einen operativen Behandlungsalgorithmus, der im Rahmen einer retrospektiven Studie in Hinblick auf die Komplikationsrate und anthropometrische Daten der Brust über 7 Jahre evaluiert wurden.

Patienten und Methoden

Im Rahmen einer retrospektiven Kohortenstudie wurden 36 Patientinnen über einen Zeitraum von 7±3,2 Jahren nachuntersucht. Alle Patientinnen wurden nach dem vorgeschlagenen Therapiealgorithmus operiert. Zur Objektivierung der postoperativen Ergebnisse wurden die Patientinnen in einem Zeitraum bis zu 10 Jahre postoperativ nachuntersucht. Es wurden klinischen Daten wie Komplikationen, Baker-Grad, Ptose-Grad und anthropometrische Daten erhoben, 3-D Aufnahmen der Brust angefertigt und ein validierte patientensubjektive Lebensqualitätsuntersuchung (Breast-Q™) erhoben.

Ergebnisse

Alloplastische-Augmentation zeigten eine signifikant höhere Komplikationsrate (42%) im Vergleich zur autologen Eigenfetttransplantation (7,69%). Es zeigt sich eine durchschnittliche Differenz des Areolendurchmessers im Seitenvergleich von 0,37 cm bei autologer Rekonstruktion und 0,78 cm bei alloplastischer Augmentation. Der errechnete Symmetrieindex ergab bei beiden Therapieverfahren 93% [1]. Alle objektiven Messverfahren zeigen einen langanhaltenden, symmetrischen, Therapieerfolg bei der Korrektur kongenitaler Fehlbildung. Die mittlere patientensubjektive Ergebniszufriedenheit (Breast-Q™) lag langzeitlich betrachtet bei 74%. Patientinnen mit autologer Rekonstruktion benötigten im Durchschnitt 2,9 Eingriffe, um das gewünschte Ergebnis zu erzielen, verglichen mit 1,3 Eingriffen bei der Alloplastischen Augmentation.

Schlussfolgerung

Der Therapiealgorithmus zeigte sich im Hinblick auf Komplikationsrate, Brustsymmetrie, Mamillen-Areolen-Komplex (MAK)-Symmetrie und Patientenzufriedenheit als valide und kann bei Patientinnen mit kongenitaler Fehlbildung der Brust in Betracht gezogen werden. Alloplastische Rekonstruktion sollte auf Grund der erhöhten Komplikationsrate kritisch diskutiert werden.

Abstract

Background

Congenital deformities of the female breast pose a unique surgical challenge, requiring an individualized approach, particularly for young patients. In this article, we describe a surgical treatment algorithm evaluated over a 7-year period through a retrospective study, focusing on complication rates and breast anthropometric data.

Patients and Methods

A retrospective cohort study was conducted, including 36 patients followed up for 7±3.2 years. All patients underwent surgery based on the proposed therapeutic algorithm. Postoperative assessments were performed at 1 and 6 weeks and 6 months to 10 years. Clinical data, including complications, Baker grade, ptosis degree, and anthropometric measurements, were collected. Additionally, 3D breast images were taken, and a validated patient-reported quality of life outcome measure (Breast-Q™) was administered.

Results

Alloplastic augmentation exhibited a significantly higher complication rate (42%) compared with autologous fat transplantation (7.69%). We observed a mean side-to-side difference in areolar diameter of 0.37 cm for autologous reconstruction and 0.78 cm for alloplastic augmentation. The calculated symmetry index revealed 93% symmetry for both therapeutic approaches. All objective measurement methods demonstrated a lasting, symmetrical therapeutic success in correcting congenital deformities. Long-term patient-reported result satisfaction (Breast-Q™) was 74%. Patients undergoing autologous reconstruction required an average of 2.9 procedures to achieve the desired outcome, compared with 1.3 procedures for alloplastic augmentation.

Conclusion

The therapeutic algorithm proved to be valid in terms of complication rates, breast symmetry, nipple-areolar complex (NAC) symmetry, and patient satisfaction. It can be considered for patients with congenital breast deformities. Alloplastic reconstruction should be critically discussed due to its increased complication rate.

Schlüsselwörter

tubuläre Brustdeformität - tuberöse Brust - Mammaasymmetrie - autologer Lipotransfer - Brustaugmentation - Aesthetisch-Plastische Chirurgie

Keywords

tuberous breast - breast asymmetry - autologous lipotransfer - breast augmentation - tubular breast deformity

Publication History

Received: 24 January 2024

Accepted: 17 February 2025

Article published online:
31 March 2025

• Literatur

• 1 Rees TD, Aston SJ. The tuberous breast. Clin Plast Surg 1976; 3: 339-347
• 2 Grolleau JL, Lanfrey E, Lavigne B. et al. Breast base anomalies: treatment strategy for tuberous breasts, minor deformities, and asymmetry. Plast Reconstr Surg 1999; 104: 2040-2048
• 3 von Heimburg D, Exner K, Kruft S. et al. The tuberous breast deformity: classification and treatment. Br J Plast Surg 1996; 49: 339-345
• 4 DeLuca-Pytell DM, Piazza RC, Holding JC. et al The incidence of tuberous breast deformity in asymmetric and symmetric mammaplasty patients. Plast Reconstr Surg 2005; 116: 1894-1899 discussion 1900-1891
• 5 Prantl LWC, Heine N, Brix E. et al Die tuberöse Brustdeformität – ein Behandlungsalgorithmus. Plast Chir 2019; 2019 4: 191-197
• 6 Prantl L, Rennekampff HO, Giunta RE. et al. Current Perceptions of Lipofilling on the Basis of the New Guideline on “Autologous Fat Grafting”. Handchir Mikrochir Plast Chir 2016; 48: 330-336
• 7 Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969; 44: 291-303
• 8 Rehnke RD, Groening RM, Van Buskirk ER. et al. Anatomy of the Superficial Fascia System of the Breast: A Comprehensive Theory of Breast Fascial Anatomy. Plast Reconstr Surg 2018; 142: 1135-1144
• 9 Meara JG, Kolker A, Bartlett G. et al. Tuberous breast deformity: principles and practice. Ann Plast Surg 2000; 45: 607-611
• 10 Hanke A, Prantl L, Wenzel C. et al. Semi-automated extraction and characterization of Stromal Vascular Fraction using a new medical device. Clin Hemorheol Microcirc 2016; 64: 403-412
• 11 Eigenberger A, Felthaus O, Schratzenstaller T. et al. The Effects of Shear Force-Based Processing of Lipoaspirates on White Adipose Tissue and the Differentiation Potential of Adipose Derived Stem Cells. Cells 2022; 11
• 12 Prantl L, Eigenberger A, Klein S. et al. Shear Force Processing of Lipoaspirates for Stem Cell Enrichment Does Not Affect Secretome of Human Cells Detected by Mass Spectrometry In Vitro. Plast Reconstr Surg 2020; 146: 749e-758e
• 13 Surgery IISoAaP. 2022 ISPAS International survey on aesthetic/cosmetic procedures perforemed in 2021. ISAPS International Survey 2022
• 14 Kolker AR, Collins MS. Tuberous breast deformity: classification and treatment strategy for improving consistency in aesthetic correction. Plast Reconstr Surg 2015; 135: 73-86
• 15 Ribeiro L, Canzi W, Buss A. et al Tuberous breast: a new approach. Plast Reconstr Surg 1998; 101: 42-50 discussion 51-42
• 16 Puckett CL, Concannon MJ. Augmenting the narrow-based breast: the unfurling technique to prevent the double-bubble deformity. Aesthetic Plast Surg 1990; 14: 15-19
• 17 Hammond DC. Atlas of aesthetic breast surgery. Elsevier Inc; 2009
• 18 Caterson SA, Singh M, Talbot SG. et al. Reconstruction of Areolar Projection Using a Purse-String Suture Technique. Plast Reconstr Surg Glob Open 2015; 3: e453
• 19 Prantl LWC, Heine N, Brix E. et al. Die tuberöse Brustdeformität- ein Behandlungsalgorithmus. In: Plastische Chirurgie. Kaden-Verlag; 2019
• 20 Longo B, Farcomeni A, Ferri G. et al. The BREAST-V: a unifying predictive formula for volume assessment in small, medium, and large breasts. Plast Reconstr Surg 2013; 132: 1e-7e
• 21 Huang NS, Quan CL, Mo M. et al. A prospective study of breast anthropomorphic measurements, volume and ptosis in 605 Asian patients with breast cancer or benign breast disease. PLoS One 2017; 12: e0172122
• 22 Ji K, Luan J, Liu C. et al. A prospective study of breast dynamic morphological changes after dual-plane augmentation mammaplasty with 3D scanning technique. PLoS One 2014; 9: e93010
• 23 Hartmann R, Weiherer M, Schiltz D. et al. New aspects in digital breast assessment: further refinement of a method for automated digital anthropometry. Arch Gynecol Obstet 2021; 303: 721-728
• 24 Wang AT, Panayi AC, Fischer S. et al. Patient-reported Outcomes After Reduction Mammoplasty Using Breast-Q: A Systematic Review and Meta-analysis. Aesthet Surg J 2022;
• 25 Brebant V, Weiherer M, Noisser V. et al. Implants Versus Lipograft: Analysis of Long-Term Results Following Congenital Breast Asymmetry Correction. Aesthetic Plast Surg 2022; 46: 2228-2236
• 26 Prantl L, Gerken M, Zeman F. et al. Incidence of Anaplastic Large Cell Lymphoma and Breast-Implant-Associated Lymphoma – An Analysis of a Certified Tumor Registry over 17 Years. J Clin Med 2020; 9
• 27 Noisser V, Eigenberger A, Weiherer M. et al. Surgery of congenital breast asymmetry-which objective parameter influences the subjective satisfaction with long-term results. Arch Gynecol Obstet 2022; 306: 1395-1397
• 28 Hauben DJ, Adler N, Silfen R. et al. Breast-areola-nipple proportion. Ann Plast Surg 2003; 50: 510-513
• 29 Nahabedian MY. Large-Volume Autologous Fat Grafting to the Breast. Aesthet Surg J 2021; 41: S16-S24
• 30 Prantl L, Eigenberger A, Reinhard R. et al. Cell-Enriched Lipotransfer (CELT) Improves Tissue Regeneration and Rejuvenation without Substantial Manipulation of the Adipose Tissue Graft. Cells 2022; 11