title: Treatment of grade 3 tuberous breasts with Puckett's technique (modified) and fat grafting to correct the constricting ring.
abstract: BACKGROUND
  Augmentation of tuberous breasts classified as grade 3 is a challenge to surgeons. The authors describe their technique for correcting grade 3 tuberous breasts with a book-shaped opening of the breast, insertion of an anatomic prosthesis, and fat grafting.
  
  
  METHODS
  The authors' technique for correcting grade 3 tuberous breasts consists of reducing the areolar diameter and performing a book-shaped opening of the breast, applying a modified version of Puckett's technique. The modification consists of opening each breast, remodeling the glandular flap on each side to make them symmetric, inserting the same size subglandular anatomic prosthesis, and covering the prosthesis with the glandular flaps held in place by transcutaneous fixation stitches. After 6 months, fat grafting of the remaining constricting ring and the cleavage is performed.
  
  
  RESULTS
  The study enrolled 28 patients with asymmetric bilateral tuberous breasts ages 18 to 39 years. At 12 months, using a questionnaire to rate their results, 68% of the patients were "very satisfied," 25% were "satisfied," and 7% were "not satisfied." The medical team's ratings at 12 months were "excellent" for 82% of the cases and "good" for 18% of the cases.
  
  
  CONCLUSIONS
  For patients with grade 3 tuberous breasts, the authors perform aesthetic breast enlargement by reducing the size of the areola, making a book-shaped opening in the breast, and carrying out fat grafting to correct the cleavage and the remaining constricting ring. The patients and the medical team both expressed high levels of satisfaction with the results.
authors.affiliation: Hospital Quirón Barcelona, Institute of Aesthetic and Plastic Surgery, Plaza Alfonso Comin, 5-7, 08023, Barcelona, Spain. serrarenom@gmail.com
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Serra-Renom
authors.forename: Juan
authors.initials: J
authors.lastname: Muñoz-Olmo
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Serra-Mestre
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000293:Adolescent; D000328:Adult; D001940:Breast / Q000002:abnormalities* / Q000601:surgery*; D019928:Breast Implantation / Q000379:methods*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006085:Graft Survival; D006801:Humans; D017060:Patient Satisfaction; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult