Breast Malformation

Key Points

• Correction of breast volume irregularities and ptosis (sagging)
• Procedure can be reimbursed by Social Security under specific conditions 
• High patient satisfaction with both functional and aesthetic outcomes

Understanding Breast Malformations

Breast malformations are common and often cause significant functional and psychological distress. Proper treatment begins with an accurate diagnosis to determine the most suitable surgical technique. In many cases, these surgeries are covered by health insurance.

Tuberous Breasts

This congenital malformation presents in three degrees, each requiring different surgical strategies. The common feature is an underdeveloped lower breast base, giving the breast a “tubular” shape that often causes it to tilt downward.

Common characteristics include:

• Elevated inframammary fold
• Disproportionately large areola-nipple complex
• Abnormal breast volume (usually hypoplastic, but may be normal or hypertrophic)
• Asymmetry (seen in over two-thirds of cases)
• Bilateral involvement, often with varying severity

Treatment aims for natural and symmetrical results. Fat grafting (lipofilling) has transformed this approach. We systematically begin with a fat injection to enhance the underdeveloped lower pole, followed by either a second fat graft or silicone implant, depending on the case.

Read more about prosthesis surgery in our article on breast implant replacement.

Poland Syndrome

Poland Syndrome is a rare congenital condition involving underdeveloped breast tissue and chest wall anomalies. It may also include upper limb abnormalities. The minimal form involves the absence of the pectoralis major’s sternocostal head, while the mammary gland may be hypoplastic or absent. The areola-nipple complex is often small, laterally displaced, or even missing.

Surgical Treatment:

• In moderate cases: breast implant combined with lipofilling or subclavicular implant
• In more complex cases, reconstruction techniques derived from post-cancer surgery, especially repeated fat grafting

Breast Asymmetry

Social Security considers breast asymmetry pathological when there’s at least a one-cup size difference. While typically congenital, asymmetry can also result from infections, surgeries, or breastfeeding.

Treatment options:

• Mild cases: lipofilling
• Pronounced cases: lipofilling + implant placement
• If one breast is hypertrophic and ptotic, breast reduction with an anchor (T-shaped) scar

Inverted Nipple (Invaginated Nipple)

Although often benign, an inverted nipple can be a source of significant functional and psychological distress, especially when it interferes with breastfeeding or intimate life.

Causes

• Overdeveloped smooth muscle fibers
• Retraction of fibrous tissue surrounding the milk ducts

Treatment Options

Medical:

• Philips Niplette® device to gradually pull the nipple outward
• In some cases, subcutaneous Botox injections

Surgical (recommended if medical methods fail or breastfeeding is not planned):

1. Flapless Technique

• Central incision of the nipple, cutting fibrous bands on both sides
• Simple, no external scars
• 10% recurrence rate
• Breastfeeding is not possible afterward

2. Flap Technique

• Two triangular flaps of areolar skin are tunneled into the nipple for support
• Allows for future breastfeeding
• Rare recurrence
• Small scars around the areola may occur

Both techniques are performed under local anesthesia with sedation. Most cases are treated on an outpatient basis or even in the clinic.

Note: Smoking must be stopped 1 week before and 15 days after surgery.

Diagnostic & Preoperative Assessment

• CT scan: for associated chest wall anomalies

Mammogram & MRI: required if fat transfer is planned

Photos