Treating Anisomastia and Tuberous Breast with Fat Grafting: Technique and Evaluation of Outcomes Using BREAST-Q Surveys

Abstract

Dear Editor, We have read the article entitled ‘‘Treating Anisomastia and Tuberous Breast with Fat Grafting: Technique and Evaluation of Outcomes Using BREAST-Q Surveys’’ by Papadopoulos S et al. [1] in Aesthetic Plastic Surgery with great interest. The authors performed percutaneous fasciotomies and fat grafting by the body-jet technique to correct tuberous breasts and anisomastia. BREAST-Q surveys were used to analyse the outcomes. As a result, the breast satisfaction scores, the psychological well-being scores and the sexual well-being scores were significantly increased. We are very grateful to the authors for this clinically instructive study; at the mean time we would like to exchange views and share our insights on some issues. Tuberous breast deformity leads to a poorer quality of life for the woman and causes psychosocial discomfort as well as within their sexual life [2]. It often results in breast asymmetry and poses a great challenge for surgical correction. Tuberous breast constitutes a difficult congenital breast anomaly that arises from a pathology in the mammary glandular structure and presented at the age of puberty. The characteristics of the tuberous breast deformity include: parenchymal hypoplasia, breast base constriction, inferior breast skin deficiency, superior malposition of the IMF, areolar herniation, and asymmetry [3]. According to Papadopoulos S et al., fat grafting can achieve the same or even higher degrees of satisfaction as an implant-based correction. From our perspective, this view is too arbitrary and the authors do not provide sufficient evidence to support it. Brault N et al. [4] conducted a study to compare satisfaction and health-related quality of life in patients affected by tuberous breast deformity between breast implants and autologous fat grafting. The results show that breast implant-augmented patients were significantly more satisfied concerning the ‘‘satisfaction with breasts’’ module and the ‘‘satisfaction with outcome’’ module. In the study, the degree of breast asymmetry was determined on the basis of the presumed volume to be resected or added in the symmetrization process. However, the reproducibility and accuracy of this evaluation method remain to be proved. In addition, the authors only evaluated the preoperative symmetry. Although the patient report questionnaire was used after the surgery, such results were too subjective, and objective data measurements were needed to increase the effectiveness of the results. Threedimensional scanning technique has significant advantages in assessing breast volume, which allows better evaluation of breast symmetry. Kasielska-Trojan A et al. [5] compared the objective and subjective evaluation of aesthetic results of breast symmetrization and proved that 3D imaging is helpful in planning breast symmetrization procedures. Combination of this method with clinical experience results in good postoperative effects. In conclusion, the authors demonstrated that fat grafting can be a true alternative in the treatment of tuberous breast deformity in patients with the appropriate fat deposits. We & Jie Luan [email protected]