Tubular breast

Classification according to ICD-10
Q83.80	Tubular breast
ICD-10 online (WHO version 2019)

The tubular breast (or tuberous breast ) is a congenital and rare malformation of the breast , which appears with puberty in women and can occur on one or both sides.

In 1976 the malformation was described as a clinical picture for the first time . At the beginning of 2014, the malformation was classified internationally as a disease according to ICD-10 and has since been recognized as a disease.

Synonyms

Proboscis
Tuberous breast
Hose chest
Snoopy chest
Hypoplastic breast

Cause and studies

To date, researchers have not been able to confirm a clear cause for the development of the disease.

A study published in the Canadian Journal of Plastic Surgery in 2011 suggested a genetic link. The same article suggests that tubular breasts are caused by an excess of collagen in the fascia and the other connective tissue components within the breast. This leads to abnormal glandular development that changes the shape of the breast.

Clinical appearance

The malformation is diagnosed based on its appearance. Tubular breasts are not underdeveloped breasts, a result of breastfeeding or weight loss .

The characteristics of the tubular breast can range from mild to severe and include:

Shortened skin coat
Hypoplasia of the mammary gland
enlarged areola ( Latin areola hypertrophy )
increased chest fold
restricted breast base, resulting in the tubular shape
decreased or even non-existent ability to breastfeed

Classifications of the malformation

The classification of breast malformation describes the severity of the malformation.

**Classification according to Grolleau**
Type I.	only medial lower quadrant deficient
Type II	Deficiency in both lower quadrants. The areola is down deviated. The subareolar skin segment is short.
Type III	Deficiency in all four quadrants, constriction of the base of the breast in vertical and horizontal directions

**Classification according to von Heimburg**
Type I.	only medial lower quadrant deficient
Type II	Absence of the two lower quadrants. The skin is sufficiently present, the nipple is not necessarily pointing downwards. This describes the difference to type III.
Type III	Absence of the two lower quadrants with skin deficit. The bridge is significantly shortened and the nipple is directed downwards.
Type IV	All four quadrants of the breast are diminished. The base of the breast is significantly reduced. A real hose breast is present.

therapy

The tubular breast can only be treated with surgery. This can be done at the completion of breast growth. Until then, the patient can be prescribed bra inserts to compensate for their shape.

In the case of well-developed subcutaneous and glandular tissue, an implant insert in conjunction with a reduction in the excessively large areola can lead to a good result.

If the deformity is severe, simple prosthesis implantation is insufficient because of insufficient soft tissue coverage (and the subsequent “snoopy” phenomenon). Rather, a method of gland redistribution has proven itself, whereby the glandular body is split through the access around the nipple and enough glandular tissue can be transported into the two lower quadrants so that an almost normal breast shape is created.

Individual evidence

↑ Thomas D. Rees, Sherrell J. Aston: The tuberous breast . In: Clin Plast Surg . 3, No. 2, 1976, pp. 339-46. PMID 1261187 .
↑ ICD-10-GM 2014 Systematic Directory: International Statistical Classification of Diseases and Related Health Problems . 10th edition. Deutscher Ärzte-Verlag, Cologne 2013, ISBN 978-3-7691-3537-4 .
↑ Marco Klinger, Fabio Caviggioli, Francesco Klinger, Federico Villani, Erseida Arra, Luca Di Tommaso: Tuberous breast: Morphological study and overview of a borderline entity . In: Canadian Journal of Plastic Surgery . 19, No. 2, 2011, pp. 42-44. PMID 22654530 . PMC 3328117 (free full text).
↑ JG Meara, A Kolker, G Bartkett, R Theile, K Mutischer, AD Holmes: Tuberous breast deformity: principles and practice. In: Ann Plast Surg . 2000.
↑ Hebammengemeinschaftshilfe eV (Hrsg.): Practice book: special still situations . Georg Thieme Verlag, 2012, ISBN 978-3-8304-5530-1 ( google.de [accessed July 19, 2018]).
^ Jean-Louis Grolleau, Etienne Lanfrey, Bruno Lavigne, Jean-Pierre Chavoin, Michel Costagliola: Plastic and Reconstructive Surgery . 7th edition. No. 104 , December 1999, p. 2040-2048 .
^ D von Heimburg, K Exner, S Kruft, G. Lemperle: The tuberous breast deformity: classification and treatment. In: British Journal of Plastic Surgery . No. 49 , 1996, pp. 339-345 .
↑ Heinz Bohmert, Christian J. Gabka, Phillip N. Blondeel, Thomas Schoeller, Alain Gagnon: Plastic and reconstructive surgery of the breast: 3 tables . 2nd, completely updated edition. Stuttgart 2006, ISBN 978-3-13-100562-5 , pp. 72 ( google.de [accessed on August 4, 2018]).

[1] Thomas D. Rees, Sherrell J. Aston: The tuberous breast . In: Clin Plast Surg . 3, No. 2, 1976, pp. 339-46. PMID 1261187 .

[2] ICD-10-GM 2014 Systematic Directory: International Statistical Classification of Diseases and Related Health Problems . 10th edition. Deutscher Ärzte-Verlag, Cologne 2013, ISBN 978-3-7691-3537-4 .

[Klinger_2011_42–44-3] Marco Klinger, Fabio Caviggioli, Francesco Klinger, Federico Villani, Erseida Arra, Luca Di Tommaso: Tuberous breast: Morphological study and overview of a borderline entity . In: Canadian Journal of Plastic Surgery . 19, No. 2, 2011, pp. 42-44. PMID 22654530 . PMC 3328117 (free full text).

[4] JG Meara, A Kolker, G Bartkett, R Theile, K Mutischer, AD Holmes: Tuberous breast deformity: principles and practice. In: Ann Plast Surg . 2000.

[5] Hebammengemeinschaftshilfe eV (Hrsg.): Practice book: special still situations . Georg Thieme Verlag, 2012, ISBN 978-3-8304-5530-1 ( google.de [accessed July 19, 2018]).

[6] Jean-Louis Grolleau, Etienne Lanfrey, Bruno Lavigne, Jean-Pierre Chavoin, Michel Costagliola: Plastic and Reconstructive Surgery . 7th edition. No. 104 , December 1999, p. 2040-2048 .

[7] D von Heimburg, K Exner, S Kruft, G. Lemperle: The tuberous breast deformity: classification and treatment. In: British Journal of Plastic Surgery . No. 49 , 1996, pp. 339-345 .

[8] Heinz Bohmert, Christian J. Gabka, Phillip N. Blondeel, Thomas Schoeller, Alain Gagnon: Plastic and reconstructive surgery of the breast: 3 tables . 2nd, completely updated edition. Stuttgart 2006, ISBN 978-3-13-100562-5 , pp. 72 ( google.de [accessed on August 4, 2018]).