Invited Discussion on: Circumlateral Vertical Augmentation Mastopexy for the Correction of Ptosis and Hypoplasia of the
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Circumlateral Vertical Augmentation Mastopexy for the Correction of Ptosis and Hypoplasia of the Lower Medial Quadrant in Tuberous Breast Deformity Darryl J. Hodgkinson1
Received: 8 October 2020 / Accepted: 11 October 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. In this manuscript [1], the authors reviewed an impressive number of cases of Grolleau Type I tuberous breast deformity with 26 patients and 51 breasts which they divide into two groups: those with a nipple–areolar complex less than 10 cm from the inframammary fold (69%group 1) and those with nipple–areolar complex greater than 10 cm (31%-group 2). The authors’ approach in group 1 is to resect a portion of the ptosed breast laterally, elevate the nipple areolar complex, dissect a subpectoral pocket (Tebbetts type 3) and insert a round implant into this partial subpectoral pocket. In group 2, they add a horizontal component to the lateral resection and advance breast tissue into the medial aspect of the breast. The authors report a low number of complications with their techniques and validate patient outcomes by the Breast-Q Questionnaire. For clarification, the authors reproduced the Grolleau diagram of Type I as seen in Grolleau’s original article [2]. Two cases are illustrated. In case one, the patient has a Grolleau Type I base deficiency visible on the AP view. There is no enlargement or herniation of the nipple–areolar complex, and moderate excess breast tissue is noted laterally. The patient’s post-operative result demonstrates no
& Darryl J. Hodgkinson [email protected]; https://[email protected] https://www.drhodgkinson.com.au https://www.cosmeticsurgeryoz.com 1
visible lateral scar, so presumably the breast tissue was modified internally similar to an oncoplastic procedure or a wedge resection of extra breast tissue in the lateral segment. The nipple–areolar complex remained essentially the same and was elevated into a more appropriate position. Without the distorted nipple–areolar enlargement and projection, this is less easily identified as a tuberous case and certainly differs from the cases of type 1 that were presented in Grolleau’s original article. This case could be regarded as an example of breast asymmetry in which the breast footprints are different on both sides. The result might have been achieved by expanding the breast footprint as is often done in standard breast augmentations in patients wishing to achieve an augmentation with a base diameter greater than that present at the time of evaluation [3, 4]. Scoring and release of the tight internal constrictive band is a manoeuvre often necessary in tuberous breast surgery a
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