Congenital Breast Deformities: Surgical Advances Offer Solutions

Breast development in adolescence and the teen years is an important marker in the transition to adulthood for young women. At an age typified by self-consciousness about body image, coming to terms with anomalies in breast development is particularly difficult. “Most congenital breast anomalies are not medically dangerous but can cause emotional distress”, says plastic surgeon and breast specialist Dr. Constance M. Chen. Fortunately, these conditions can usually be corrected surgically preempting long-lasting effects on self-esteem.

Breast development begins before a baby is born and while some congenital anomalies may be evident at birth, others may not become apparent until later in childhood or at puberty. While genetic factors sometimes play a role, the cause of most of these disorders is unknown.

Dr. Chen points out that many differences that may be initially worrisome – like breast buds of different sizes or breasts that develop at different rates – are part of normal development and may resolve on their own. “In these cases”, she says, “surgical intervention is best delayed until development is complete. In all cases, treatment will depend on the severity of the deformity and its psycho-social effects”.

Hypoplastic breast is a condition in which one or both breasts don’t develop normally during puberty. The result may be severely asymmetrical breasts or, if both breasts are involved, very small breasts that are out of proportion with the woman’s body. While most women with hypoplastic breasts have normal hormone levels, hormone production or regulation sometimes play a role and can affect lactation.

Treatment for hypoplastic breast is generally breast augmentation of the underdeveloped breast(s) with implants or by using a woman’s own tissue (‘autologous reconstruction’), usually taken from the abdomen, to fashion a new breast. These techniques are similar to those used for cosmetic augmentation or for breast reconstruction when a woman has lost a breast to mastectomy. When only one breast is hypoplastic, another option is to achieve symmetry by reducing the fully developed breast (‘reduction mammoplasty’).

Poland syndrome, first described by a19th-century doctor, is a congenital syndrome that develops in the first six weeks after conception and typically involves missing or underdeveloped chest muscles on one side of the body. The characteristics of Poland syndrome can vary widely and may include, in addition to an underdeveloped breast, abnormalities of the chest wall, the ribs, the arm, and the hand. Treatment is generally via reconstructive surgery and depends on the severity of the condition.

Tuberous breast deformity (also known as constricted breast) results in one or both breasts failing to develop normally during puberty. In mild cases, the affected breast may just be smaller. In more severe cases, the base of the breast may appear constricted, with less skin and volume along the crease, the crease may be positioned too high on the chest wall, or there may be bulging (herniation) of breast tissue through the areola. Treatment may include expanding the constricted breast base, lowering the crease, adding volume and skin, and reconstructing the nipple-areola complex.

Supernumerary breast tissue may develop in the embryo and cause breast tissue to be found outside its normal location on the chest, anywhere from the abdomen to the armpit. The tissue may be just a small nipple or a large amount of tissue. Treatment isn’t always necessary but depending on its location and the discomfort it causes, the tissue can be surgically removed. Polymastia (an extra breast) and polythelia (an extra nipple) can similarly be treated with surgical removal.

Correcting congenital breast deformities is often driven as much by psychological and social motivation as by medical necessity. Consultation with a plastic surgeon can help every woman evaluate her options, set appropriate expectations, and make the decision that is right for her.

Dr. Constance M. Chen

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.

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