Research Article Breast Developmental Anomalies in Dormaa...

Hindawi Publishing CorporationPlastic Surgery InternationalVolume 2013 Article ID 140704 7 pageshttpdxdoiorg1011552013140704

Research ArticleBreast Developmental Anomalies in Dormaa Municipality ofGhana Prevalence and Impact on the Life of the Individual

P Agbenorku1 E Otupiri2 and S Fugar3

1 Reconstructive Plastic Surgery and Burns Unit Komfo Anokye Teaching Hospital School of Medical SciencesKwame Nkrumah University of Science and Technology Kumasi Ghana

2Department of Community Health School of Medical Sciences Kwame Nkrumah University of Science and TechnologyKumasi Ghana

3Department of Surgery Komfo Anokye Teaching Hospital Kumasi Ghana

Correspondence should be addressed to P Agbenorku pimagbenyahoocom

Received 31 December 2012 Revised 9 February 2013 Accepted 25 February 2013

Academic Editor Nicolo Scuderi

Copyright copy 2013 P Agbenorku et al This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Background Breast developmental anomalies (BDAs) are abnormalities of breast tissue that arise during breast development Someof the anomalies can have negative impact on the personrsquos life This study seeks to assess the prevalence of BDA in the DormaaMunicipality in Ghana and its impact on the life of the individualMaterials andMethods A descriptive study involving 500 femalerespondents aged between 11 and 25 years from selected schools in theDormaaMunicipality using self-administered questionnairesand interviews Results From the study it was found that the prevalence of BDA in the municipality was 128 The commonestBDA was bilateral hypoplasia which accounted for 313 of the BDAs found in the study Nine (141) complained of the BDAaffecting their lives with most being teased in school Twenty-two (344) girls out of the 64 with BDAs had a family member witha BDA Conclusion BDA is a worry therefore comprehensive educational programs for health workers and the general public areneeded to increase awareness Also work should be done to include education on BDAwhen awareness is being raised about breastcancer and on the importance of breast self-Examination (BSE)

1 Introduction

Since the beginning of time the female breast has been asymbol of feminism and its presence is a major feature thatdelineates a man from a woman A beautiful and attractivefemale breast is one which is symmetrically situated onthe anterolateral chest wall and has soft but well-definedjunctures with the chest upper abdomen and the axillaeThebreast profile is a gentle downward vertical flow from theclavicle extending between the second and sixth ribs verti-cally and horizontally between the lateral edge of the sternumand midaxillary line to the nipple-areola and forms a mildlyconvex curve from the nipple-areola to the inframammarycrease [1 2]

Budding of the breasts (thelarche) a sign of femalesecondary sexual characteristic occurs at approximately 10-11 years and the time it takes for the breast to reach maturitycan be as short as 18months ormay take as long as nine years

During this period of breast development several processesor factors may go wrong leading to their abnormal growthThese include genetic environmental exposure to infectiousagents trauma radiation neoplastic or endocrine conditions[3ndash7]

Some of these anomaliesmay arise purely in the breast tis-sue and these include amastia (absence of breast occurs whenmammary ridges fail to develop) [8] hypoplasia (underde-veloped breasts) macromastia (massive enlargement of oneor both breasts also defined as breast enlargement exceeding600 grams) [9] and tuberoustubular breast (breast with atube-like shape caused by an incomplete development ofthe mammary gland) [10] Other breast anomalies are acces-sory nipples (polythelia) and accessory mammary glands(polymastia) these are believed to arise from an incompleteregression of the milk lines that arise embryologically [11]

Cases of BDAs have been recorded since the sixteenhundreds one such case was described in 1670 where an

2 Plastic Surgery International

autopsy performed on a patient who apparently died shortlyafter the onset of breast enlargement that weighed 64 poundsSeveral other cases have been reported since then One suchcase was described in 1993 in which a 12-year-old girl hadabnormally large breast and developed marked kyphosis asa result Apart from the physical impairment the enlargedbreast (hypertrophy) caused the girl intense psychologicalproblems incapacitating her in school activities and socialrelations [12] Also this form of large breasts has causedsome people to stop engaging in normal daily activitiesbecause of the weight [13] It has also been found that inthe majority of these patients they are young and healthybut the psychological and social impacts of these conditionsare crippling [14] Other problems encountered by somewomen include physical disabilities such as constant backpain scoliosis as well as psychological problems as a result ofinsecurities about their beauty and feminism and also teasingfrom peers [15]

Despite this long history of BDAs there is a scarcity ofresearch into these conditions The importance of BDA hasreached the point where centers are being set up in the USsolely dedicated to management BDAs among adolescents[16] Studies to investigate the awareness of breast anomaliessuch as performed by Agbenorku et al in Jamasi revealedthat the awareness of the breast anomaly was 83 among thepeople suffering from the BDA [17]

Diagnosis of BDAs is basically clinical and usuallyrequires clinical examination of the breast Careful breastexamination is needed to prevent misdiagnosis becausethese anomalies may mimic breast malignances so itis important to rule them out [18] Ultrasound is theideal imaging modality in evaluating childrenrsquos breasts [19]Management of patients with BDAs requires a multidis-ciplinary approach which includes plastic surgeons ado-lescent internists endocrinologists gynaecologists psychia-trists social workers and nutritionistsThewhole teamworksprimarily to fix any psychological problems that may existfirst and secondly to correct the anomaly surgically if desired[20]

In patients with macromastia or gigantomastia drugsare only marginally effective in reversing the conditiontherefore surgery (reduction mammaplasty) remains themainstay of treatment [21] When reduction mammaplastyis being considered in adolescent surgery should be delayeduntil breast growth is completed and this can be doneby performing serial breast measurements [22] Good skincare is also necessary in order to reduce breast creaseinflammation and lessen the symptoms caused by mois-ture [23] Tuberous breast can be treated by surgicalprocedures using tissue expansion methods [24] Breastimplants or reduction may be used to correct asymme-try

Generally the rate of patients who undergo surgery forBDA depends on the level of knowledge they have on thecondition Agbenorku et al reported in their study thatsurgery and other forms of treatment such as counselingand regular followup assessment in patients with BDA wereminimal and in terms of treatment 68were ready to acceptmedication as the only treatment for their BDA [25]

11 Surgical Techniques for BDA Management The mostimportant aspects of the anatomy of the breast are theunderstanding of the blood supply and nerve supply to thenipple areola complex (NAC) [26] It is also important tonote that the inferior pedicle has been most associated withan inverted T- skin resection a superior pediclesupermedialpedicle with a vertical skin resection The advent of pedicledtechniques improved greatly NAC viability and improvingcosmetics results [27] Studies have shown that medial andsuperomedial pedicles have excellent postoperation nip-ple sensation [28] Agbenorku et al carried out bilateralreduction mammaplasty using the nipple-areola repositiontechnique which aims to preserve the nipples and someareolar tissue to retain sensibility and future breastfeedingThey reported in their study that reduction mammaplastyplays a significant role in the relief of pain and psychologicaldistress of symptomatic macromastia patients irrespective ofavailable resources technology and country [25]

The technique employed is based on the individualpatientrsquos requirement These include horizontal pedicle(which was the Strombeck pattern with the blood supplycoming from both sides) in which the dermal pedicle issufficient to maintain nipple areolar viability but can causenipple retraction and inclusion of glandular element in thepedicle which canmake insetting difficult [29] Inferior pedi-cle helps to maintain the NAC and there is good circulationand sensation and breastfeeding possibility [30 31] Medialpedicle has good sensation and good blood supply and can beinserted relatively easy [32] Lateral pedicle has good visibilityand is based on the lateral thoracic artery perforators [33]Superior pedicle has good circulation but being a dermalpedicle breastfeeding is impossible it is not very easy to inset[34] Central pedicle is a modification of the inferior pediclewith the removal of the dermal bridge [34] Vertical bipedicleprovided good blood supply and also easy inset [35]

12 Surgery and Psychology The importance of psychologicalcounseling of patients with BDA cannot be understated It isimportant because in a study by Von Soest et al amongst 130Norwegian females who had cosmetic surgery it was foundthat a high rate of preoperative psychological problems andlow self-esteem were related to more negative psychosocialchanges after the surgery as compared to those with betterpsychological health [36] Thus it is important to tacklethe psychological aspect ideally even before the surgicalcorrection takes place Psychological management is alsoimportant because some of the individuals with these breastanomalies have an underlying body dysmorphic disorder[37]

2 Materials and Methods

21 Study Setting Dormaa Municipal is located at the west-ern part of the Brong-Ahafo Region of Ghana It lies withinlongitudes 3∘ west and 3∘ 301015840 west and latitudes 7∘ northand 7∘ 301015840 north Jaman and Berekum Districts bound thedistrict on the north on the east by the Sunyani Municipalin the south and southeast by Asunafo and Asutifi Districts

Plastic Surgery International 3

respectively in the southwest by Western Region and inthe west and northwest by Cote drsquoIvoire The municipalcapital is Dormaa Ahenkro located about 80 kilometers westof the regional capital Sunyani [38] The 2002 populationcensus put Dormaa Municipality population at 150229 It isestimated that Christians constitute the largest percentage ofthe districtrsquos population accounting for 72 of the sampledpopulation Islam was 19 while other religious groupsrepresented 3

22 Materials and Methods This descriptive study was con-ducted between February andApril 2011 Consent was soughtfrom the various leaders of the community and schools beforethe questionnaires were administered The purpose of thestudy was explained to them after which the questionnaireswere administered to a total of 500 hundred female students307 from senior high school (SHS) and 193 from juniorhigh school (JHS) aged 11 to 25 in the municipality Thequestionnaire used in the collection of data developed fromprevious studies performed by Agbenorku et al on BDAs atJamasi and Sogakope consisted of both open- and closed-ended questions [17 28 39] Each respondent was shown 8pictures of various BDAs (Figures 1 2 3 4 5 6 7 and 8)

They were then asked to state if their breasts were likeany of them If their breasts were not like any of the onesdescribed they then moved to a section to assess theirsatisfaction with their breasts and knowledge of any diseaseof the breast If the respondent said that her breast was likeone of those pictures then she had to answer questions as tothe kind of impact the BDA had on her life

23 DataAnalysis Data from completed questionnaireswereanalyzed using data processing software Statistical Packagefor Social Sciences (SPSS) 16th Edition

3 Results

Figure 9 shows the distribution of the different anomaliesOut of the 500 respondents 64 (128) had BDA with thecommonest being bilateral hypoplasia 20 (313) followedbymacromastia 18 (281) Figure 10 illustrates the age distri-bution of female students with BDAMost of the respondents(784) were between the age of 15 and 20 years 53 (828) ofthose with BDA were between 15 and 19 years The mean ageof the girls with bilateral hypoplasia was 1675 years with theyoungest and the oldest being 14 and 20 years respectively

31 Problems Faced by Affected Individuals in School and atHome Out of the 64 respondents with BDA 9 (5 of themhadmacromastia while 4 had bilateral hypoplasia) complainedthat BDA affected their lives The girls with the bilateralhypoplasia complained of being teased in school howevertheir lives at home and in town were not affected in anywayThree (3) girls out of the 5 with macromastia complainedof the BDA affecting their life at home when they hadto do household chores they developed back pain and 2complained of being shy in school because of the size of theirbreasts

Figure 1 Bilateral hypoplasia in a 20-year-old

Figure 2 Left unilateral hypoplasia in a 22-year old

Figure 3 Left hyperplasia and right hypoplasia in a 16-year-old

32 Reasons for Not Seeking Medical Treatment None of thegirls with a BDAhad sought any treatment because 50 (781)out of the 64 girls did not know that their conditions wereconsidered abnormalThree (3) girls with bilateral hypoplasiahad researched into treatment options for people with small


Figure 4 Bilateral tubular breasts in a 17-year-old

Figure 5 Bilateral juvenile macromastia in a 14-year-old

Figure 6 Bilateral breast hypertrophy in a 26-year-old

breasts but were discouraged by the high cost of surgery Also10 were not aware of any treatment available (Table 1)

33 Prevalence of BDA in the Family Out of the 64 girlswith BDA 22 (344) said they had a family member witha similar condition 6 admitted to having seen the anomaly intheir mothers 22 in their sisters 5 in their aunt and 1 personadmitted seeing it in her grandmother (Table 2)

Figure 7 Bilateral accessory nipples in 45-year-old

Figure 8 Bilateral nipple anomalies (Slit nipples) in a 23 year-old

34 Attitude and Response of the Family and Community Outof the 64 respondents 14 of themwere aware they had a BDASix (94) openly complained to their families about the con-dition and the familyrsquos response to all these respondents wasthat their condition was normal Eight (125) respondentsfailed to tell anyone about their condition because they felttoo shy to tell anyone in their family

35 Knowledge of Breast Diseases Out of the 500 femalesinterviewed 134 (268) girls were not satisfied with theirbreasts 97 (72) would be willing to have surgery performedto improve the look of their breasts Thirty out of 97 wantedthe size of their breasts to be increased 65 wanted theirbreasts to be reduced while the 2 wanted to fix the droopynature of their breasts (augmentation) Thirty respondentsout of the 64 (469) with BDA were willing to havesurgical correction of their anomaly On knowledge of breastdisease 367 (734) of the girls had heard of breast cancerwhen asked whether they knew anyone apart of themselvesor anyone in their family with BDA 27 (54) admittedknowing someone with a BDA

4 Discussion

In this study the prevalence of BDAwas 128This is similarto findings done in other parts of the country where theprevalence recorded by Agbenorku et al was 13 and 127in Jamasi and Sogakope respectively [17 39] More research


0

5

10

15

20

25

Uni

late

ral

hypo

plas

ia

Mac

rom

astia

Bila

tera

l hy

popl

asia

Nip

ple

anom

alie

s

Tubu

lar

brea

st

Freq

uenc

y

Breast anomalies

Acce

ssor

yni

pple

s

Figure 9 Forms of BDAs in respondents

Freq

uenc

y

02468

10121416

12 13 14 15 16 17 18 19 20Age (years)

Age distribution of BDAs

Figure 10 Age distribution of respondents with BDAs

on BDA has to be conducted since prevalence in other areascould be high

From this study the commonest BDA found among therespondents was bilateral hypoplasia followed bymacromas-tia Bilateral hypoplasia was reported much more frequently(307) in this study than in other similar studies done inGhana 171 in Sogakope and 218 in Jamasi In a studycarried out by Simmons [16] among adolescents in the USit revealed that polythelia and asymmetry were the mostcommon BDAs The prevalence of BDAs in this presentstudy and other studies in Ghana was relatively higher thanthat found among Japanese where studies on young femalesrevealed a prevalence of accessory nipples to be 5 [40 41]Some people may be of the view that breasts of the girlshad not begun developing explaining the high prevalence ofbilateral hypoplasia but this cannot be the reason for thehigh rate of breast hypoplasia because the average age of thegirls with bilateral hypoplasia was 1675 years when in generalmost girlsrsquo breasts begin to develop between the ages of 10and 11 years therefore the higher rate of breast hypoplasiamay be attributed to other factors One possible factor is thatit could have arisen from the fact that this study design wasa subjective design and unlike the other studies performedin the other areas where there was actual breast examinationby the research team so the personrsquos perception of their ownbreasts played a huge role in determining their choice

Macromastia accounted for 281 of the BDAsThis valueis not as high as those from other studies done in Ghana byAgbenorku et al in Jamasi and Sogakope where macromastiaaccounted for 436 and 400 respectively [17 39]

Table 1 Reasons for not seeking treatment

Reason Frequency PercentageNot aware of disease 50 781Not aware of treatment 10 156Too expensive 3 47Has no time for treatment 1 16Any other reason 0 0Total 64 100

Table 2 Prevalence of BDA in the family

BDATotal casesseen amongrespondents

People withthe same

condition intheir family

withoccurrence inthe family

Unilateral hypoplasia 3 0 0Macromastia 18 5 278Bilateral hypoplasia 20 8 40Accessory nipples 8 3 375Nipple anomalies 10 4 400Tubular breasts 5 2 20Totals 64 22 344

A total of 344 of the respondents with a BDA had afamily member with a similar condition (Table 2) This issimilar to 31 reported by Agbenorku et al in Jamasi [17]This could mean that there is likely a genetic predispositionto the inheritance of BDA Haagensen reported that there is agenetic element to BDAswhen he noticed that the occurrenceof polymastia or polythelia was inheritable condition [42]

In this study 219 were aware that they had a BDAThis is quite low as compared to the awareness level of 63recorded by Agbenorku et al in Jamasi [17] Awareness onBDA needs to be put in place in order to sensitize the generalpublic Regular breast self-examination (BSE) could resultin early detection of these anomalies A study conducted inSaudi Arabia revealed only 303 of the women had heardabout BSE and 187 reported they practiced BSE withinthe previous year [43] Also a similar study undertaken inNigeria by Okobia et al showed that women lacked enoughknowledge about breast cancer 349 claimed to have ever-practiced BSE [44]

From the study 67 wanted a reduction of their breastsHowever this is in contrast to a survey undertaken by Fred-erick on 26703 American female adults where it was foundthat 70 of females were dissatisfied with their breasts andwanted more ample breasts [45] This in response betweenthe Ghanaians and Americans could be as a result of the factthat society plays a major role dictating the ldquoideal breast sizerdquoand this perception would strongly influence their decisionto either reduce or increase their breasts In the United Statesthere is constant social andmedia pressure for women to havebig breasts

Surgery is the best treatment option for BDA As much as469 respondentswanted to have surgical correction of their


breastsThis rate is much higher than that seen in the study inJamasi where 205 of the girls with the BDAwere willing tohave surgical correction of their breasts [17] The higher ratesof acceptance of surgery in this study may arise from the factthat in this study the girls were not given any other treatmentoption such as drugs as a method of treatment which wasan option in the Jamasi study The treatment options werelimited to surgical management because drug therapy is noteffective

BDA could have such negative impacts on the lives ofpeople From this present study 141 (119899 = 9) said thatthe anomaly was affecting their life in school or at homenegatively However the situation in this present study differsfrom a similar study conducted by Agbenorku et al at Jamasiwhich revealed that among those with BDA it had no effecton their school and family life [17] Benditte-Klepetko et alcarried out a study on 50 women with various breast sizesand concluded that that high breast weight has a negativeinfluence on the physical and psychological morbidity ofwomen [46] Gozu et al also stated in his study on a 12-year-old girl suffering from breast hypertrophy that althoughthe deformity is benign it affects patients physically andpsychologically [47] Somma et al reported a case of a 12-yearold girl with juvenile hypertrophy of breast which caused herintense psychological problems incapacitating her in schoolactivities and social relations [18]More education is thereforeneeded to help persons with BDA to develop a positive selfimage

5 Conclusion

The study revealed that the prevalence of breast developmen-tal anomalies in the Dormaa Municipality is high The studyalso showed that some girls are negatively affected by thiscondition hence education on BDA should be promoted toincrease awareness of the condition This form of educationshould also enlighten the public on treatment measuresavailable People should also be educated and encouraged topractice breast self-examination

Ethical Approval

The appropriate ethical approval was obtained from theCommittee on Human Research Publications and Ethics ofthe Kwame Nkrumah University of Science and TechnologySchool of Medical Sciences and Komfo Anokye TeachingHospital Kumasi

Conflict of Interests

The authors declare that they have no conflict of interests

References

[1] J Bostwick ldquoBreast augmentation reduction and mastopexyrdquoin Plastic Surgery Principles and Practice M J Jurkiewicz T JKrizek S J Mathes and Ariyan Eds pp 458ndash467 Mosby StLouis Mo USA 1990

[2] M A Shermak ldquoCongenital and developmental abnormalitiesof the breastrdquo inManagement of Breast Diseases I Jatoi and MKaufmann Eds pp 37ndash49 Springer New York NY USA 1stedition 2010

[3] L S Neinstein ldquoBreast disease in adolescents and youngwomenrdquo Pediatric Clinics of North America vol 46 no 3 pp607ndash629 1999

[4] R N Matthews and F T Khan ldquoA seat belt injury to the femalebreastrdquo British Journal of Plastic Surgery vol 51 no 8 p 6531998

[5] N S Rosenfield J O Haller and W E Berdon ldquoFailure ofthe development of the growing breast after radiation therapyrdquoPediatric Radiology vol 19 no 2 pp 124ndash127 1989

[6] S A Bloom and M Y Nahabedian ldquoGestational macromastiaa medical and surgical challengerdquo Breast Journal vol 14 no 5pp 492ndash495 2008

[7] D Ravichandran and S Naz ldquoA study of children and ado-lescents referred to a rapid diagnosis breast clinicrdquo EuropeanJournal of Pediatric Surgery vol 16 no 5 pp 303ndash306 2006

[8] M J Arca and D A Caniano ldquoBreast disorders in the adoles-cent patientrdquoAdolescent Medicine Clinics vol 15 no 3 pp 473ndash485 2004

[9] K Sharma S Nigam N Khurana and K U Chaturvedi ldquoUni-lateral gestational macromastia-a rare disorderrdquoTheMalaysianjournal of pathology vol 26 no 2 pp 125ndash128 2004

[10] C J Gabka H Bohmert and P N Blondeel Plastic andReconstructive Surgery of the Breast Thieme Publishing GroupNew York NY USA 2009

[11] T Sadler and L J Langman Medical Dictionary LippincottWilliams ampWilkins Philadelphia Pa USA 2006

[12] M Tadaoki K Komaki T Mori et al ldquoJuvenile Gigantomastiareport of a caserdquo Surgery Today of Japan pp 260ndash264 1993

[13] L Blomqvist A Eriksson and Y Brandberg ldquoReductionmammaplasty provides long-term improvement in health statusand quality of liferdquo Plastic and Reconstructive Surgery vol 106no 5 pp 991ndash997 2000

[14] D Kulkarni and M Dixon ldquoCongenital Abnormalities of thebreastrdquoWomenrsquos Health pp 75ndash88 2012

[15] W Chrominski B Madej R Maciejewski K Torres RCiechanek and F Burdan ldquoA development anomaly of themammary glands-gigantomastia A case reportrdquo Folia Morpho-logica vol 62 no 4 pp 517ndash518 2003

[16] P S Simmons ldquoAnomalies of the adolescent breastrdquo Paediatricsand Child Health vol 18 no 1 pp S5ndashS7 2008

[17] P AgbenorkuMAgbenorku A Iddi et al ldquoAwareness of breastdevelopmental anomalies a study in Jamasi Ghanardquo AestheticPlastic Surgery vol 35 no 5 pp 745ndash749 2011

[18] F Somma C Calzoni S Arleo et al ldquoPolythelia and supernu-merary breast Personal experience and review of the literaturerdquoAnnali Italiani di Chirurgia vol 83 no 2 pp 109ndash112 2012

[19] C J Garcıa A Espinoza V Dinamarca et al ldquoBreast US inchildren and adolescentsrdquo Radiographics vol 20 no 6 pp1605ndash1612 2000

[20] Pediatric Views ldquoRetrieved January 30 2012 from ChildrenrsquosHospital Bostonrdquo 2007 httpwwwchildrenshospitalorgviewsaugust07finding solutions to adolescent breast probl-emshtml

[21] G A Rahman I A Adigun and I F Yusuf ldquoMacromastia areview of presentation and managementrdquo The Nigerian Post-graduate Medical Journal vol 17 no 1 pp 45ndash49 2010


[22] J O Schorge J I Schaffer L M Halvorson et al WilliamsGynecology McGraw-Hill New York NY USA 2008

[23] Breast Reduction ldquoRetrieved January 30 2012 fromWikipediardquo 2012 httpenwikipediaorgwikiBreast reduc-tion

[24] A D Versaci andA A Rozzelle ldquoTreatment of tuberous breastsutilizing tissue expansionrdquo Aesthetic Plastic Surgery vol 15 no4 pp 307ndash312 1991

[25] P Agbenorku G Agamah M Agbenorku and M ObengldquoReduction mammaplasty in a developing country a guidelinefor plastic surgeons for patient selectionrdquo Aesthetic PlasticSurgery vol 36 no 1 pp 91ndash96 2011

[26] J Bostwick 3rd Plastic and Reconstructive Breast Surgery vol 12000

[27] M S Ahmed ldquoA simplified superior pedicle technique forreduction mammaplastyrdquo Journal of Plastic Reconstructive ampAesthetic Surgery vol 30 no 1 pp 57ndash61 2006

[28] M Y Nahabedian and M M Mofid ldquoViability and sensationof the nipple-areolar complex after reduction mammaplastyrdquoAnnals of Plastic Surgery vol 49 no 1 pp 24ndash32 2002

[29] J O Strombeck ldquoMammaplasty report of a new techniquebased on the two-pedicle procedurerdquo British Journal of PlasticSurgery C vol 13 pp 79ndash90 1960

[30] P Regnault ldquoReduction mammaplasty by the ldquoBrdquo techniquerdquoPlastic and Reconstructive Surgery vol 53 p 19 1974

[31] T H Robbins ldquoA reduction mammaplasty with the areolanipple based on an inferior dermal pediclerdquo Plastic and Recon-structive Surgery vol 59 no 1 pp 64ndash67 1977

[32] H Moustapha H C Dennis and N Foad Vertical ScarMammaplasty Spring Berlin Germany 2005

[33] T Skoog ldquoA technique for breast reduction transposition ofthe nipple on a cutaneous vascular pediclerdquo Acta chirurgicaScandinavica vol 126 pp 453ndash465 1963

[34] E Courtiiss and R Goldwyn ldquoReduction mammaplasty by theinferior pedicle techniquerdquo Plastic amp Reconstructive Surgeryvol 59 no 1 pp 64ndash67 1977

[35] P K McKissock ldquoReduction mammaplasty with a verticaldermal flaprdquo Plastic and Reconstructive Surgery vol 49 no 3pp 245ndash252 1972

[36] T Von Soest I Kvalem K Skolleborg et al ldquoPsychosocialchanges after cosmetic surgery a 5-year follow-up studyrdquoPlasticand Reconstructive Surgery vol 128 no 3 pp 765ndash772 2011

[37] D J Castle R J Honigman and K A Phillips ldquoDoes cosmeticsurgery improve psychosocial wellbeingrdquo Medical Journal ofAustralia vol 176 no 12 pp 601ndash604 2002

[38] Dormaa Municipal Assembly ldquomunicipality infoRetrieved January 5 2012 from Dormaa Municipalrdquo 2006httpwwwdormaaghanadistrictsgovgh

[39] P Agbenorku M Agbenorku A Iddi et al ldquoIncidence ofbreast developmental anomalies a study at Sogakope GhanardquoNigerian Journal of Plastic Surgery vol 6 no 1 pp 1ndash5 2010

[40] M Clement-Jones S Schiller E Rao et al ldquoThe short staturehomeobox gene SHOX is involved in skeletal abnormalities inTurner syndromerdquoHuman Molecular Genetics vol 9 no 5 pp695ndash702 2000

[41] M Lee ldquoGrowth Hormone deficiency as the only identidablecause for primary amennorrheardquo Journal of Pediatric andAdolescent Gynecology vol 13 no 2 pp 93ndash95 2000

[42] C D Haagensen ldquoBreastsrdquo in Handbook of Congenital Mal-formation A Rubin Ed pp 398ndash401 WB Saunders CoPhiladelphia Pa USA 1967

[43] S Jahan A M Al-Saigul andM H Abdelgadir ldquoBreast cancerKnowledge attitudes and practices of breast self examinationamong women in Qassim region of Saudi Arabiardquo SaudiMedical Journal vol 27 no 11 pp 1737ndash1741 2006

[44] M N Okobia C H Bunker F E Okonofua and U OsimeldquoKnowledge attitude and practice of Nigerian women towardsbreast cancer a cross-sectional studyrdquoWorld Journal of SurgicalOncology vol 4 p 11 2006

[45] D A Frederick A Peplau and J Lever ldquoThe barbie mystiquesatisfaction with breast size and shape across the lifespanrdquoInternational Journal of Sexual Health vol 20 no 3 pp 200ndash211 2008

[46] H Benditte-Klepetko V Leisser T Paternostro-Sluga et alldquoHypertrophy of the breast a problem of beauty or healthrdquoJournal of Womenrsquos Health vol 16 no 7 pp 1062ndash1069 2007

[47] A Gozu F N Yogun Z Ozsoy A Ozdemir G Ozgurhanand S Tuzlali ldquoJuvenile breast hypertrophyrdquo Journal of BreastHealth vol 6 no 3 pp 122ndash124 2010

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autopsy performed on a patient who apparently died shortlyafter the onset of breast enlargement that weighed 64 poundsSeveral other cases have been reported since then One suchcase was described in 1993 in which a 12-year-old girl hadabnormally large breast and developed marked kyphosis asa result Apart from the physical impairment the enlargedbreast (hypertrophy) caused the girl intense psychologicalproblems incapacitating her in school activities and socialrelations [12] Also this form of large breasts has causedsome people to stop engaging in normal daily activitiesbecause of the weight [13] It has also been found that inthe majority of these patients they are young and healthybut the psychological and social impacts of these conditionsare crippling [14] Other problems encountered by somewomen include physical disabilities such as constant backpain scoliosis as well as psychological problems as a result ofinsecurities about their beauty and feminism and also teasingfrom peers [15]

Despite this long history of BDAs there is a scarcity ofresearch into these conditions The importance of BDA hasreached the point where centers are being set up in the USsolely dedicated to management BDAs among adolescents[16] Studies to investigate the awareness of breast anomaliessuch as performed by Agbenorku et al in Jamasi revealedthat the awareness of the breast anomaly was 83 among thepeople suffering from the BDA [17]

Diagnosis of BDAs is basically clinical and usuallyrequires clinical examination of the breast Careful breastexamination is needed to prevent misdiagnosis becausethese anomalies may mimic breast malignances so itis important to rule them out [18] Ultrasound is theideal imaging modality in evaluating childrenrsquos breasts [19]Management of patients with BDAs requires a multidis-ciplinary approach which includes plastic surgeons ado-lescent internists endocrinologists gynaecologists psychia-trists social workers and nutritionistsThewhole teamworksprimarily to fix any psychological problems that may existfirst and secondly to correct the anomaly surgically if desired[20]

In patients with macromastia or gigantomastia drugsare only marginally effective in reversing the conditiontherefore surgery (reduction mammaplasty) remains themainstay of treatment [21] When reduction mammaplastyis being considered in adolescent surgery should be delayeduntil breast growth is completed and this can be doneby performing serial breast measurements [22] Good skincare is also necessary in order to reduce breast creaseinflammation and lessen the symptoms caused by mois-ture [23] Tuberous breast can be treated by surgicalprocedures using tissue expansion methods [24] Breastimplants or reduction may be used to correct asymme-try

Generally the rate of patients who undergo surgery forBDA depends on the level of knowledge they have on thecondition Agbenorku et al reported in their study thatsurgery and other forms of treatment such as counselingand regular followup assessment in patients with BDA wereminimal and in terms of treatment 68were ready to acceptmedication as the only treatment for their BDA [25]

11 Surgical Techniques for BDA Management The mostimportant aspects of the anatomy of the breast are theunderstanding of the blood supply and nerve supply to thenipple areola complex (NAC) [26] It is also important tonote that the inferior pedicle has been most associated withan inverted T- skin resection a superior pediclesupermedialpedicle with a vertical skin resection The advent of pedicledtechniques improved greatly NAC viability and improvingcosmetics results [27] Studies have shown that medial andsuperomedial pedicles have excellent postoperation nip-ple sensation [28] Agbenorku et al carried out bilateralreduction mammaplasty using the nipple-areola repositiontechnique which aims to preserve the nipples and someareolar tissue to retain sensibility and future breastfeedingThey reported in their study that reduction mammaplastyplays a significant role in the relief of pain and psychologicaldistress of symptomatic macromastia patients irrespective ofavailable resources technology and country [25]

The technique employed is based on the individualpatientrsquos requirement These include horizontal pedicle(which was the Strombeck pattern with the blood supplycoming from both sides) in which the dermal pedicle issufficient to maintain nipple areolar viability but can causenipple retraction and inclusion of glandular element in thepedicle which canmake insetting difficult [29] Inferior pedi-cle helps to maintain the NAC and there is good circulationand sensation and breastfeeding possibility [30 31] Medialpedicle has good sensation and good blood supply and can beinserted relatively easy [32] Lateral pedicle has good visibilityand is based on the lateral thoracic artery perforators [33]Superior pedicle has good circulation but being a dermalpedicle breastfeeding is impossible it is not very easy to inset[34] Central pedicle is a modification of the inferior pediclewith the removal of the dermal bridge [34] Vertical bipedicleprovided good blood supply and also easy inset [35]

12 Surgery and Psychology The importance of psychologicalcounseling of patients with BDA cannot be understated It isimportant because in a study by Von Soest et al amongst 130Norwegian females who had cosmetic surgery it was foundthat a high rate of preoperative psychological problems andlow self-esteem were related to more negative psychosocialchanges after the surgery as compared to those with betterpsychological health [36] Thus it is important to tacklethe psychological aspect ideally even before the surgicalcorrection takes place Psychological management is alsoimportant because some of the individuals with these breastanomalies have an underlying body dysmorphic disorder[37]

2 Materials and Methods

21 Study Setting Dormaa Municipal is located at the west-ern part of the Brong-Ahafo Region of Ghana It lies withinlongitudes 3∘ west and 3∘ 301015840 west and latitudes 7∘ northand 7∘ 301015840 north Jaman and Berekum Districts bound thedistrict on the north on the east by the Sunyani Municipalin the south and southeast by Asunafo and Asutifi Districts






3 Results

















4 Discussion



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OncologyJournal of





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OncologyJournal of





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Research Article Breast Developmental Anomalies in Dormaa...

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