Treatment for breast hypoplasia depends on whether there is a treatable hormonal imbalance, which can be treated medically by a Pediatric Endocriologist. If this is not the case, then the mainstay of treatment for breast hypoplasia is surgery. Operations for breast hypoplasia include breast augmentation with implants, fat transfer and the Brava System, either alone or in combination with fat transfer. Surgery for tuberous breasts is targeted to the specific aspects of the individual’s breasts but often consists of breast augmentation together with release of the constricted lower half of the breast, repositioning of the fold under the breast lower on the chest and removing the outer part of the wide nipple areolar complex.
Breast augmentation is an operation to increase the size of the breast and usually involves inserting a breast implant under the breast tissue. Occasionally, if there is not enough breast tissue to hide the implant, it is necessary to position the implant under the muscle behind the breast. Breast implants are usually made of a silicone outer shell, which can be smooth or textured, and the implant can be filled either with silicone gel or with Saline, salty water. There are advantages and disadvantages to all of these options and your surgeon will guide you towards the implant best suited to your needs. The disadvantage of using a breast implant is that they can cause complications even years after their insertion including a change in position of the implant, infection requiring removal of the implant to treat, a firm, visible or even painful capsule that forms around the implant and the implant rupturing causing a change in shape and size of the breast.
Fat Transfer is a procedure in which fat is removed from elsewhere in the body by liposuction, prepared by separating the fat cells from the other parts of the material removed, and injecting them into the breast. While this technique can be effective in the right patient, the results are less predictable than a breast implant, especially when the technique is used for large size increases. Often multiple operations are needed to achieve the final shape for the breasts.
An alternative to a breast implant is a relatively new technique, the Brava Bra, which is a suction device that patients wear at least 10 hours per day for roughly three months. It can be effective in increasing breast size by one or two cup sizes but there are concerns that these results are temporary and that breasts treated this way lose their size when treatment stops. To reduce the chance of this, the Brava Bra can be used in combination with fat transfer, which appears to improve the longevity of the technique. It has the advantage of not requiring an implant and the ongoing consequences of having an implant, but the disadvantage is that the lifelong outcome from the technique is not yet fully known. It is a technique that we can offer at Children’s Health℠. Aftercare is important for breast hypoplasia as breast shape and size will alter through changes in weight, after pregnancy or just over time. If implants are used, aftercare is especially important as even many years after surgery, these can become infected, can shift position or rotate, can form a hard or painful capsule around them, can rupture or can even come through the skin. In these cases, further surgery is likely to be required. The chest is an area that changes dramatically during early adulthood so it is important that any treatment for breast hypoplasia is planned to give the best long-term result into adulthood.