Correction of the tuberous breast deformity in a prepubescent male patient: A surgical approach to an unusual problem

Abstract

Purpose: The management of the tuberous breast deformity in the female patient is well described. However, the presence of this variant in male patients is particularly rare, and few reports on the management of this condition are available.

Case presentation: A 12-year-old prepubescent male with bilateral gynecomastia and tuberous breast deformities was referred to our department for treatment. Our surgical management, including free nipple areolar complex harvest, mastectomy, removal of excess skin and subsequent nipple grafting, is presented in detail. We observed a cosmetically acceptable result with restoration of a masculine-appearing nipple-areolar complex and good patient satisfaction at 6-month follow-up.

Conclusions: Tuberous breast deformities in male patients are rare. Our treatment of a prepubertal male patient with this deformity using mastectomies and free nipple areolar complex grafting provided a cosmetically acceptable result. Here, we review the current literature on tuberous breast deformities in males and describe our approach to treatment.

Keywords: Breast; Gynecomastia; Male; Nipple; Pediatric; Tuberous.

Figure 1

Preoperative patient photographs. A prepubescent, 12-year-old male with bilateral gynecomastia and tuberous breast deformity is shown in the frontal (a), left oblique (b), left lateral (c), right oblique (d), and right lateral (e) positions.

Figure 2

Marking and harvesting of the male nipple areolar complex. (a) The periphery of the overdeveloped areolae was marked. (b) Nipple-areolar complexes were resized to 20 mm using the plunger flange of a syringe. (c) Elliptical markings were made incorporating the native nipple areolar complex. (d) Intra-areolar incision and harvest of new nipple-areola complex as full thickness graft (Figure 2d).

Figure 3

Mastectomy for gynecomastia. (a) Elliptical incision incorporating the native nipple areolar complex. (b) Development of mastectomy flaps. (c) Excised breast tissue and overlying nipple areolar complex placed over breast skin.

Figure 4

Construction of new nipple-areolar complex with free nipple grafts. (a) Markings and measurements for the free nipple grafts. Grafts were placed just medial to the inferolateral border of the pectoralis muscle with a sternal notch-to-nipple distance of 14 cm and 10 cm lateral to the sternal midline bilaterally. (b) Inset of the free nipple grafts onto de-epithelialised recipient sites using half-buried horizontal mattress sutures. (c) Bolsters of sterilised cotton balls wrapped in xeroform and bacitracin applied and secured with silk sutures. (d) Final appearance of chest with bolsters in place.

Figure 5

Postoperative patient photographs. 6-month follow-up views in the frontal (a), left oblique (b), left lateral (c), right oblique (d), and right lateral (e) positions.