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• W2022116323 abstract "Sir: Iatrogenic pediatric breast deformity may result from thoracostomy, thoracotomy, or tumor excision.1 Patients with deformational breast injuries tend to have hypoplastic breasts from breast bud injury and may require augmentation. We describe a novel technique for managing breast deformity associated with neonatal tube thoracostomy. An 18-year-old woman, born prematurely at 24 weeks, required bilateral chest tubes for respiratory failure as a neonate. She presented with medialization of the breast with a significant chest wall and breast deformity (Fig. 1).Fig. 1.: (Above) Preoperative frontal, three-quarter, and lateral views. The lateral aspect of the right breast is displaced 4 cm medially, with the midaxillary line displaced anteriorly. (Below) Postoperative views show that breast contour was restored.The depressed deformity was marked. The patient was positioned supine with the right arm abducted less than 90 degrees; the depressed scar was released. The deltopectoral fascia was identified and a subglandular pocket was developed. The dissection extended from the costal margin to the sternal notch and inframammary fold. The tethered breast parenchyma was divided longitudinally. The subglandular flap was advanced and the breast tissue was sutured along the anterior axillary line to create volume and to lateralize the breast mound. The objective was to release the tissue aggressively so it would fill the defect. After 3 years of follow-up, the patient remains satisfied with the result. The breast contour was restored and remained symmetrical when compared with the contralateral side. There is adequate excursion, and the scar is mildly noticeable. Breast development begins at 5 to 7 weeks of fetal development as a bilateral thickening of the ectoderm which involutes shortly after forming. However, a limited portion in the thoracic region remains and develops into the neonatal breast.2,3 In infant cadaver dissections, the breast bud tissue (mamma ductules and glands) is distributed at least 1.5 cm around the nipple-areola complex.4 Therefore, dissection or trauma in this area may damage future breast tissue and lead to incomplete breast development.5 A common pediatric breast injury results from tube thoracostomy. The site develops a scar that may tether breast tissue to the chest wall, leading to a localized contour deformity. Scar release is necessary to allow normal breast growth during puberty. Breast hypoplasia may result from thoracotomy with violation of the breast bud. Thoracotomy incisions must be placed to avoid this complication.4 In these cases, breast implant placement might be required. The proposed technique achieves a tension-free reconstruction with an acceptable aesthetic result. Furthermore, there is adequate tissue excursion without tethering. Possible limitations include the lack of fullness in the lateral aspect of the breast and the lateralization of the nipple-areola complex. These findings were present preoperatively. Furthermore, the patient gained weight between the time the preoperative and postoperative images were taken. Interestingly, the corrected breast gained proportional volume at the surgical site; therefore, postoperative healing has not impeded fat accumulation. Although the results are encouraging, Cherup et al. found volume differences greater than 20 percent in 60 percent of patients who underwent thoracotomy as children.4 The subglandular breast advancement flap may be a valuable tool for breast malformation reconstruction after tube thoracostomy. Julio A. Clavijo-Alvarez, M.D., Ph.D. Alex Wong, M.D. Division of Plastic and Reconstructive Surgery University of Pittsburgh Pittsburgh, Pa. Guy Stofman, M.D. Plastic and Reconstructive Surgery UPMC Mercy Hospital Pittsburgh, Pa." @default.
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• W2022116323 date "2009-04-01" @default.
• W2022116323 modified "2023-09-25" @default.
• W2022116323 title "Management of Iatrogenic Breast Deformity after Neonatal Tube Thoracostomy Placement" @default.
• W2022116323 cites W2009841693 @default.
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• W2022116323 doi "https://doi.org/10.1097/prs.0b013e31819e5c66" @default.
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