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Teenage Breast Problems |
To be a teenager and have anything that makes you feel like you are different
is extremely difficult. Teenagers with breast assymetries often hide this
condition and are extremely embarrassed about it. Teenagers sometimes mention to
their mothers that something is different about one of their breasts, and the
mother often will downplay this saying that most women are slightly asymmetric,
while in fact the teenager is trying to tell the mother that she has a
significant problem. Commonly the mother often does not realize the teenager has
a marked difference in the size of her breasts until the mother accidently walks
in on the teenager while she is getting changed.
Teenagers tend to feel isolated and often have a marked improvement in their
personalities, becoming more outgoing and more confident following breast
reconstruction. It is for these reasons that it is important to identify early
on any breast anomalies and to expedite the teenagers receiving treatment.
The most common breast problem that teenagers present with is asymmetry. In
severe cases this may be a difference in several cup sizes however even milder
asymmetries are often very distressing to the teenager.
As soon as a significant discrepancy in breast size is noted, the
underdeveloping breast can be treated with placement of a tissue expander. The
tissue expander can remain in place throughout the teenagers developing years
and serially inflated as needed, to keep symmetry between the two breasts. Once
breast development is completed on the opposite side, the tissue expander can be
removed and a permanent saline implant can be placed. In girls who have finished
development and have only a small discrepancy a one stage reconstruction can be
done by simply pacing an implant in the smaller breast.
In cases of severe congenital asymmetry, sometimes a reduction can be done on
the larger side, as well as a tissue expander and subsequently an implant placed
on the smaller side. Most cases of asymmetry however can be handled primarily by
placing a tissue expander in the affected breast. The tissue expander can then
be filled slowly first to match the size of the opposite breast and then to
maintain symmetry as growth proceeds. This process is well tolerated by
teenagers in the outpatient clinic and does not require an anesthetic. The
incision is placed in the inframammary area and is not visible even when the
teen wears a bikini or is naked, as it is hidden by the natural overhang of the
breast. Most commonly the tissue expander is placed above the pectoralis muscle,
just under the breast tissue. If the implant is placed under the pectoralis
muscle it often ends up being too high and the droop of the reconstructed breast
does not match the non-operated upon side. Once breast symmetry has been
achieved in the initial postop period with inflation of the tissue expander, the
teen is usually seen in three to six month intervals, depending upon how much
growth is seen in the opposite breast. Once stabilized for approximately one
year and there is good symmetry between the two sides, a final permanent breast
implant can be placed. Occasionally a crescent mastopexy (or breast lift) is
done on the opposite breast in order to improve symmetry.
Poland’s syndrome can also sometimes be diagnosed for the first time in
teenagers. Poland’s syndrome consists of the congenital absence of the
pectoralis major muscle and can be associated with ipsilateral brachiosyndactaly
(short , webbed fingers)as well as rib anomalies. There is no breast development
on the involved side and in severe cases there is not even a nipple areolar
complex. The absent breast can be corrected with again, placement of a tissue
expander and subsequent placement of a breast implant and in some cases, the
transfer of the latissimus muscle from the back to the breast side to recreate
the anterior axillary line. I have found that breast reconstruction can also
camouflage the absence of the muscle significantly so that transfer of the
latissimus muscle is not always needed. In boys, the recreation of the anterior
axillary line in the chest wall contour by the pectoralis muscle must be weighed
against the loss of the normal contour of the back with the loss of the
latissimus muscle.
Traumatic injury to the developing breasts can also occur from previous
surgeries such as thoracotomies in infancy, deep second or third degree burns to
the chest area, irradiation to the chest wall for treatment of a tumor as an
infant, or even from a hemangioma in the breast area. Each of these cases must
be treated individually.
In the case of a hemangioma, the atrophic tissue from the hemangioma can be
partially excised. This may restore the nipple into a position more commensurate
with the opposite side. An implant may be necessary to supplement the volume of
the developing breasts as lack of development can be seen subsequent to a
hemangioma.
Previous scars from surgery can be released, as well as burn scars. If burn
scars are tethering the breast tissue, full release of the breast tissue with a
skin graft releasing the nipple to the same level as the normal nipple which
usually allows full development of the breast. In these cases an implant or
tissue expander is usually not necessary. Of course in severe cases where the
nipple and areolar area have been destroyed, usually the breast bud has also
been destroyed and both of these would need to be reconstructed.
In cases where the child has received radiation as an infant, the rib cage as
well as the breast usually does not develop to the same extent as the opposite
side. In these cases it is important to point out the asymmetries to the child
and to the parents, so that they will understand that the overall chest
dimensions are different and therefore perfect symmetry would be difficult to
achieve on either side.
Currently under the US Food and Drug Administration (FDA) guidelines, both
silicone and saline implants are available for reconstruction but only saline
implants are available for augmentation. Although adolescents with congenital
asymmetry would fall under the category of reconstruction, in general I have
used only saline implants for teenagers with marked asymmetry. If there is
adequate breast tissue over the implant, rippling which is a problem associated
with saline implants, is not seen and therefore saline implants are an excellent
choice for these patients.
Correction of breast asymmetry has been associated with relatively few
complications. The major complication is deflation of the tissue expander, which
must be replaced. This can be very traumatic to the teenagers and I warn them
that this can happen at some time, although it is relatively rare. I have left
tissue expanders in for as long as five to seven years and have noted no other
adverse complications. The saline is absorbed by the body and in some cases if
the teen has or is close to our time of planning to place a permanent implant, I
remove the deflated tissue expander and place the permanent implant, obviating
the need for an extra surgical procedure.
With this type of surgery, the scars in general do well and there is a minimal
risk of loss of nipple sensation and or breast feeding ability. When the
teenager is old enough to eventually need mammography, she should inform the
mammographer that she has an implant in place, so that an additional view can be
obtained to maximize visualization of breast tissue.
The overall positive response to teenagers undergoing this surgery has been
overwhelming. Due to the intense psychological effect of any breast anomaly, the
earlier the diagnosis is made and the child receives treatment, I feel the
better off for all involved. There is no reason to delay treatment until the
teenager reaches full development and this only further prolongs the
psychological difficulties of the teenager. |
Source:
http://www.lookingyourbest.com/articles/susandowney.php
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