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Breast Deformity | Cholecystectomy


The diagnosis of Tubular Breast Deformity can go unrecognised

by patients and some doctors, with the condition simply

assumed to be ‘small’ breasts. However, it is a specific

developmental abnormality that can cause great distress to the

individual and impact greatly on their psychosocial functioning.

The characteristic features of this deformity are a narrow breast base associated

with a large and herniated nipple-areola complex. As a consequence, the shape

of the breast resembles more a ‘tube’ than a mound. Other terms that have been

applied to this condition include ‘tuberous breast’, ‘constricted breast’ and even

‘Snoopy breast deformity’.There is a spectrum of severity, and one proposed

classification by Heimburg et al


is illustrated in

Figure 1


Figure 1. Classification of Tuberous Breast Deformity

Counselling and Treatment

Patients with Tubular Breast Deformity are often extremely self-conscious at the

time of examination, and must be handled with great sensitivity and patience.

They are often relieved when informed that there is a specific diagnosis, and

overjoyed 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.The

scars are confined to the areolar border, and therefore quite inconspicuous


Figure 2


Figure 2. Preoperative and postoperative photographs of a patient with

Bilateral Tubular Breast Deformity, left more severe than the right.



Heimburg v.D., Exner K., Kruft S. and Lemperle G.TheTuberous Breast Deformity:

Classification andTreatment. British Journal of Plastic Surgery (1996), 49, 339-345.

Mr Roy L. H. Ng, MA DM FRCS (Plast)

Consultant Plastic Surgeon

London Bridge Hospital

Tubular Breast


Mr Marshall, a laparoscopic and Upper GI

surgeon, who has been with Newham

University Hospital NHS Trust for three

years, has pioneered a new technique for

Cholecystectomy operations over the last

18 months.An honorary Consultant Surgeon

with Bart’s and LondonTrust, and Honorary

Senior Lecturer at the Institute of Cancer

at Charterhouse Square, Mr Marshall has

recently joined the London Bridge Hospital

and will be offering this procedure

to patients who require a


The technique employs an ultrasonic

dissector (or Harmonic scalpel) as

the sole instrument for dissection

and sealing of the cystic artery and

duct.The operation is performed in

a retrograde, or fundus first, manner

which enhances the display of the anatomy

and allows the surgeon to see the operative

field more clearly.The use of the Harmonic

scalpel eliminates the need for electrosurgery

in this operation; which is a further benefit to

the patient because of the concerns regarding

inadvertent injury to abdominal structures

and ‘smoke’ production.The technique

enables more than 90% of patients who have

undergone this type of Cholecystectomy, to

go home the same day as their surgery.As a

result of this rapid recovery, the technique

has been selected for presentation at three

international meetings over the last 12 months.

This unique operative technique has

significantly improved the recovery

period and improved the patients’

experiences during this historically

unpleasant procedure. Mr Marshall is an

experienced laparoscopic surgeon; using this

dynamic technique for hernia repairs, both

inguinal and incisional, surgery for reflux

disease, bowel surgery and obesity treatment.

The Department of Health has picked up

on this technique and is looking to use

it as the standard for ‘best practice’ for

Cholecystectomy surgery.

Images: Ethicon Endo-Surgery, a division

of Johnson & Johnson Medical Limited has

provided the supporting images. However,

it is not responsible for any editorial material.

New technique

for operation of


Mr Marshall

Mr Roy Ng is a consultant plastic surgeon at Guy’s and St

Thomas’ Hospitals NHS Trust, and at London Bridge Hospital.

He has extensive experience in reconstructive and aesthetic

surgery of the breast, including postmastectomy, developmental

and postpregnancy deformities. He has a particular interest

in the developmental problem of Tubular Breasts. Here, he

describes the condition and approaches to its management.