Dr. Alejandro Nogueira's Case #ELTBPIY3

Dr. Alejandro Nogueira developed his own technique to treat tuberous breasts in the early 2000s due to the shortcomings, poor results and serious complications typically associated with the traditional and worldwide used aforementioned techniques.

Severe criticisms have always arisen from the use of traditional tuberous breast correction glanduloplasties, essentially due to their inability to rebuild and fill the missing lower pole of the tuberous breasts, their incomplete decompression of the glandular constriction, the partial eradication of the breast conicity, in many cases also their physical unfeasibility because of the extreme firmness of the rebellious tuberous breasts which precludes their technical application, the common occurrence of vascular complications like ischemia or necrosis, implant losses, the persistence of a double bubble deformity, recurrence or persistence of the tuberosity, unsuitability to host breast implants, etc.

It is a popular belief among worldwide plastic surgeons that the tuberous breast correction techniques are, in the best case, suboptimal and fail to provide a comprehensive and safe all-purposes solution for any type and grade of tuberous or tubular breast deformity.

In order to address the limitations and risks of traditional techniques Dr. Alejandro Nogueira designed his own glanduloplasty method which he has been perfecting during several decades on hundreds of tuberous breast patients.

Dr. Alejandro Nogueira's 4 flaps tuberous glanduloplasty technique tackles the key goals any surgical procedure should provide to the patient seeking tuberous breast correction; Dr. Alejandro Nogueira's 4 flaps technique features complete eradication of the conicity minimizing recurrence, comprehensive reshaping of all breast mound quadrants, efficient decompression, suited to host breast implants of any volume embracing them in a easy and smooth manner, prevention of double bubble deformity, vascular safety and low risk of complications, feasible in any modality and severity of tuberosity, moderate complexity, reliability and predictability.

Dr. Alejandro Nogueira's 4 flaps technique consists in tailoring four pyramid shaped glandular slices via an apical access through the areola, not requiring eversion of the breast's deep surface, neither splitting the skin from the gland and avoiding the tailoring of glandular flaps with uncertain vascularity; it is fully compatible with the underlying presence of breast implants; another critical advantage is its versatility, since allows trimming any of the four flaps down to a desired shape or size in order to customize the result or to prevent vascular complications.

Thorough usage and testing of this technique, including very long term follow up of the patients, has provided evidence beyond any shade of doubt of the advantages and superiority of Dr. Alejandro Nogueira's 4 flaps technique above and beyond any other traditional or modern glanduloplasty option.

Dr. Alejandro Nogueira's 4 flaps technique is reputed by its excellent vascularity, with no cases of significant necrosis reported, neither one single implant loss has been associated to it; it is also compatible with pregnancy, breast feeding, mammograms and any medical intervention; work, sports and physical activities are perfectly compatible with it too.

Sensation preservation at the nipples is one of its most remarkable advantages.

This case's set of images has both informative and educational purposes for patients and surgeons, aiming to convey an understandable three dimensional vision of the technique's geometry, design and execution, as well as intraoperative step by step movie frames allowing a good acquisition of how the technique is performed.

The patient suffered a very high grade of complete tuberous breast deformity, including a double constriction ring encircling the whole breast perimeter and another one next to the areola, enlarged and herniated areolas, severe conicity, very high inframammary crease and total absence of the lower breast pole; thus Dr. Alejandro Nogueira's 4 flaps technique was indicated, showing its maximum splendour in this case.