Health Matters - London Bridge Hospital

Breast Deformity | CholecystectomyTubular BreastDeformityMr Roy Ng is a consultant plastic surgeon at Guy’s and StThomas’ Hospitals NHS Trust, and at London Bridge Hospital.He has extensive experience in reconstructive and aestheticsurgery of the breast, including postmastectomy, developmentaland postpregnancy deformities. He has a particular interestin the developmental problem of Tubular Breasts. Here, hedescribes the condition and approaches to its management.The diagnosis of Tubular Breast Deformity can go unrecognisedby patients and some doctors, with the condition simplyassumed to be ‘small’ breasts. However, it is a specificdevelopmental abnormality that can cause great distress to theindividual and impact greatly on their psychosocial functioning.The characteristic features of this deformity are a narrow breast base associatedwith a large and herniated nipple-areola complex. As a consequence, the shapeof the breast resembles more a ‘tube’ than a mound. Other terms that have beenapplied to this condition include ‘tuberous breast’, ‘constricted breast’ and even‘Snoopy breast deformity’. There is a spectrum of severity, and one proposedclassification by Heimburg et al 1 is illustrated in Figure 1.Figure 1. Classification of Tuberous Breast DeformityCounselling and TreatmentNew techniquefor operation ofCholecystectomyMr Marshall, a laparoscopic and Upper GIsurgeon, who has been with NewhamUniversity Hospital NHS Trust for threeyears, has pioneered a new technique forCholecystectomy operations over the last18 months. An honorary Consultant Surgeonwith Bart’s and London Trust, and HonorarySenior Lecturer at the Institute of Cancerat Charterhouse Square, Mr Marshall hasrecently joined the London Bridge Hospitaland will be offering this procedureto patients who require aCholecystectomy.The technique employs an ultrasonicdissector (or Harmonic scalpel) asthe sole instrument for dissectionand sealing of the cystic artery andduct. The operation is performed ina retrograde, or fundus first, mannerwhich enhances the display of the anatomyand allows the surgeon to see the operativefield more clearly. The use of the Harmonicscalpel eliminates the need for electrosurgeryin this operation; which is a further benefit tothe patient because of the concerns regardinginadvertent injury to abdominal structuresand ‘smoke’ production. The techniqueenables more than 90% of patients who haveundergone this type of Cholecystectomy, togo home the same day as their surgery. As aresult of this rapid recovery, the techniquehas been selected for presentation at threeinternational meetings over the last 12 months.This unique operative technique hasPatients with Tubular Breast Deformity are often extremely self-conscious at thetime of examination, and must be handled with great sensitivity and patience.They are often relieved when informed that there is a specific diagnosis, andoverjoyed when informed that effective treatment is possible.The deformity is readily corrected surgically. By means of a periareolar incision,the breast base is widened, volume is increased by insertion of a breast implant,and the nipple-areola herniation is corrected by a ‘doughnut’ mastopexy. Thescars are confined to the areolar border, and therefore quite inconspicuous(Figure 2).significantly improved the recoveryperiod and improved the patients’experiences during this historicallyunpleasant procedure. Mr Marshall is anexperienced laparoscopic surgeon; using thisdynamic technique for hernia repairs, bothinguinal and incisional, surgery for refluxdisease, bowel surgery and obesity treatment.The Department of Health has picked upon this technique and is looking to useit as the standard for ‘best practice’ forCholecystectomy surgery.Images: Ethicon Endo-Surgery, a divisionof Johnson & Johnson Medical Limited hasprovided the supporting images. However,it is not responsible for any editorial material.8Figure 2. Preoperative and postoperative photographs of a patient withBilateral Tubular Breast Deformity, left more severe than the right.References1Heimburg v.D., Exner K., Kruft S. and Lemperle G. The Tuberous Breast Deformity:Classification and Treatment. British Journal of Plastic Surgery (1996), 49, 339-345.Mr Roy L. H. Ng, MA DM FRCS (Plast)Consultant Plastic SurgeonLondon Bridge Hospitalwww.royng.co.ukMr Marshall