Pediatric Plastic and Craniofacial Surgery
The Center for Pediatric and Adolescent Breast Surgery at Cohen Children’s specializes in the repair of deformities in the chest area in teens and young adults. Breast asymmetry and deformities can develop in early or late puberty and can affect both boys and girls.
Our plastic surgeons correct problems with the size and shape of the breast. We repair how the breast looks, as well as the underlying cause of the problem. Surgical correction can be achieved often with minimal scars, which can be concealed in the natural contours of the breast.
At the Center for Pediatric and Adolescent Breast Surgery, we provide advanced treatment for children with a variety of conditions affecting the breast, including
Poland syndrome is a congenital malformation of the breast. The breast tissue, nipple and underlying chest wall musculature may be absent. The hand and arm on the affected side may be smaller, short and webbed. The web spaces for the hand are typically released from age 6-12 months, depending on the degree of severity. The breast reconstruction begins during initial breast growth (11-13 years old) where an adjustable implant can be placed. As your child grows the implant can be filled to match the opposite side. At skeletal maturity, a permanent implant and muscle reconstruction is often required. In addition, upper extremity and hand anomalies may be present. Surgery to improve function of the webbed fingers may be necessary.
Juvenile breast hypertrophy, or enlargement, may occur during the early phase of puberty. This can involve one or both breasts, causing neck and shoulder pain in addition to severe drooping. Plastic surgery specialists can offer techniques ranging from liposculpture and short scar vertical reductions to traditional anchor type scars. The surgery is performed on an outpatient basis, typically after maturity, and can offer a restoration to a more aesthetically pleasing and comfortable breast size.
Amastia is the failure to develop breast tissue and may be part of an underlying syndrome or as an isolated event. After a complete physical exam, options for breast reconstruction include either implant based or tissue based. Often a temporary expander can be placed in a patient who is still developing, and filled as needed to maintain symmetry until the completion of growth has occurred. At that time, a permanent implant or a tissue based reconstruction can be offered.
Athelia is the absence of the nipple and areola. The nipple can be reconstructed by a simple outpatient surgery by rearranging local tissue. The areola can often be reconstructed either using skin grafts or by medical tattooing.
Male breast enlargement may occur soon after puberty as a result of the imbalance of estrogen and testosterone. Gynecomastia is more common in overweight children since fat cells predispose the body to higher estrogen levels. Weight loss and hormone therapy is often an initial treatment for the condition. Pediatric endocrinologists may offer medication to decrease estrogen levels potentially reversing the growth of breast tissue.
When severe, or irreversible, the breast tissue can be removed surgically during an outpatient procedure. Scars around the nipple and/or underneath the breast may be used to access the tissue for removal. When very severe, a mastectomy with a free nipple graft, replacing the nipple in a new position may be required.
Tuberous breast deformity involves a constriction of the base of the breast. In addition, a widening of the areola and a narrow asymmetric breast are often present. Surgical correction can be achieved by expanding the tight base and narrowing the areola. An implant may be required to achieve size symmetry.
Burns and trauma
Severe scarring and chest wall deformity can result from childhood burns and trauma causing poor development of the breast and chest wall. Multiple stage reconstructions are often necessary to release the tight scars and secondarily reconstruct the normal anatomy of the chest wall. The breast mound can be reconstructed using tissue from the abdomen or thighs as well as possibly tissue expanders and implants. Nipples can be reconstructed using local flaps and good aesthetic outcomes can be achieved.