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| Dr. Joel Aronowitz - Tubular Breast Correction Surgery with Dr. A |
Dr.
Joel Aronowitz: "Hi everyone, and welcome
back to the channel. Today, we have a case of a tubular breast deformity. This
is a young woman who had a very significant weight loss as well as
childbearing, and she lost virtually all of the volume in her breast. But in addition,
the breast has a shape issue called a tubular breast deformity, also known as a
tuberous breast deformity or a Snoopy nose-shaped breast. This is caused by a
fibrous layer beneath the skin. It's a layer that constricts the growth of the
breast with puberty and with weight gain or with pregnancy. And that layer
constricts all of the growth of the breast with the exception of the
nipple-areola. So, that entire nipple area does not have that fibrous layer; so
therefore, the nipple can be the most projecting part of the breast. And that's
what gives the breast its typical shape, but in the case of a tuberous breast,
that layer is too tight.
So if it's too tight in the lower pole, that
is below the nipple, then you'll have a breast that kind of flops over too
quickly and a very constricted distance between the nipple and the inframammary
fold. If it's too tight immediately toward the sternum, then it will bring the
nipples closer together and be kind of a cross-eyed looking breast, if you
will, where the nipples are pointing toward each other.
I hope you enjoyed this case. I want to
express appreciation to the patient for allowing us to share her surgery with
you. Now, we've dissected a pocket for the implant, and it's going to be, we've
gone through the areola here, and the pocket is all the way behind the breast,
and the fold of the breast is right here, but we're going to lower the fold a
little bit so that this distance can be a more normal distance between the
nipple and the inframammary fold. And for women, most women will have a distance
of four to five centimeters between the lower part of the areola and the fold,
or about six, seven centimeters between the nipple itself and the fold. And in
her case, as I showed you preoperatively, it's only about one, one and a half
centimeters.
So here, you can see where her breast wants to
fold right here. So, we're going to put in an implant, and then you'll see that
this tissue on her chest becomes recruited onto the breast so that the breast
has extra skin there where it needs it. And also, on the inside, I've released
the fibrous layer that I described earlier so that it can expand.
Here is my breast implant. This is saline, and
I'm going to roll it into a little roll here so that it will slip into my
incision more readily. The implant is happy in there. 'Are you happy, little
implant?' When you suck out that last bit of air in the implant so it's
completely deflated, we want to fill it just with the saline; we don't want any
liquid in there. And now we'll start to fill it up. And this will be 50 cc. So,
I'll show you in a moment what this looks like completely filled up.
So now, you can see the incision we partially
closed. You can see the implant now inflated at 450. And basically, that
implant is going to fill out down here so that the lower pole of the breast is
larger. We have a bigger distance here, so we have less of that constriction
because if it's constricted, it'll do this. The upper pole will stretch
abnormally, and the lower pole won't. So, we want this lower pole distance to
be greater so that this will end up stretching more, and it'll be a normal
sagging of the breast over time.
Now, let's review what we've done. We start
with a tubular breast, and the breast is very deflated because this patient had
lost a lot of weight. We put an implant behind the breast and released the
fibrous tissue so that the breast envelope could expand, and we even lowered
the fold a little bit, which we usually don't do, so that the distance between
the nipple and the fold was a healthier length of about 5 centimeters instead
of very constricted. Then we did a donut mastopexy. We took a donut of skin out
around the nipple and constricted it with a purse-string suture. So, this is
our result, and you'll see that the implant's a fairly big implant. It creates
more of a bulge up here, but with time, this distance is going to stretch out
and give her a better shape and allow that nipple to rotate superiorly.
Well, I hope you enjoyed this surgery. We'll
try to post some follow-up pictures after a while, with the patient's
permission. Sorry about the novel studio here, but I'm traveling, and I wanted
to get this video posted for you. I hope you enjoyed this example of breast
augmentation for correction of the tuberous breast. So anyway, tuberous or
tubular breast deformity, and this is corrected with a special type of breast
augmentation. Hope you enjoyed it. If I didn't explain this properly, please
leave a question below, or any comments you have about the video for me. Okay,
later more from Aronowitzland." – Dr. Joel
Aronowitz
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