Comment on: “Circumlateral Vertical Augmentation Mastopexy for the Correction of Ptosis and Hypoplasia of the Lower Medial Quadrant in Tuberous Breast Deformity”

Abstract

Dear Sir, We read with great interest the article entitled ‘‘Circumlateral Vertical Augmentation Mastopexy for the Correction of Ptosis and Hypoplasia of the Lower Medial Quadrant in Tuberous Breast Deformity’’ [1] which summarizes the authors’ experience on tuberous breast deformity (TBD), by proposing surgical technique for the correction of hypoplasia of the lower medial quadrant in specific forms of TBD (Type I, according to Grolleau classification). We would like to congratulate Zholtikov and coworkers for their excellent paper and the cases presented. During the last decade, our group has focused on the treatment of the stenotic breast, including the most severe form, the tuberous breast. In 2016, we published an article based on a retrospective analysis on 1600 consecutive female patients admitted to our department from January 2009 to July 2014, requiring breast surgery. Based on the pre-operative pictures of these patients, we observed that almost 50% had specific deformities belonging to the group of TBD [2]. All our efforts culminated in 2017, with the publication of the paper ‘Stenotic Malformation and its Reconstructive Surgical Correction: A New Concept from Minor Deformity to Tuberous Breast’, where we proposed a new classification of the TBD [3]. Differently from other classification systems, the strength of our classification is that it takes into considerat ion the degree of ptosis applied to each type of stenosis (vertical or horizontal and vertical) and glandular trophism (hypoplastic or non-hypoplastic). The evaluation of the degree of ptosis drives the operative planning. Our classification system (based on eight different breast deformities) not only takes into consideration this important aspect, but also guides the reader to the best approach to treat each specific deformity. We understand the rationale behind the use of a circumlateral vertical mastopexy for the correction of Group I (distance between the nipple and the inframammary sulcus less than 10cm), while using a circumlateral vertical mastopexy with a horizontal component in Group II (distance between the nipple and the inframammary sulcus more than 10cm). However, moving from our experience with periareolar breast surgery in the oncological field, we believe that a periareolar mastopexy can lead to the same results. Correction of Type IV and VIII deformities, based on our classification system, can be obtained with a periareolar approach, limiting the visible scars [4, 5]: the excessive and unpleasant skin can be resected in a concentric/eccentric fashion, allowing the surgeon to position the nipple areola complex at the center of the new breast & Andrea Battistini [email protected]