Congenital Breast Malformations

Summary

Congenital breast deformities pose a challenging dilemma in plastic surgery. The expression of the abnormality may be complete, and anatomic components are often missing, deformed, or weakened. Most breasts are naturally asymmetrical. These asymmetries may include discrepancies in breast size and shape, location of the nipple–areola complex, the inframammary fold, or skeletal abnormalities (see Figure 29.1). Breast abnormalities can cause emotional and psychological trauma, resulting in social maladjustment and associated behavioral problems. The majority of patients are young healthy individuals who seek aesthetic restoration of their deformities.

Preoperative evaluation begins with a thorough medical and surgical history, particularly related to breast disease. Physical examination includes identification of chest wall or musculoskeletal deformities; shape, symmetry, and volume of both breasts; the presence and degree of ptosis; the position of the inframammary folds; and anomalies of the nipple—areola complex. Most of these anomalies require a multistage surgical approach, and the patient must be extensively counseled.