Breast Problems - Before and after

Contributed Dr Phillip Marazzi, a GP in East Horsley, Surrey

Gynaecomastia - before

This 58-year-old man reported almost lifelong embarrassment about his 'man breasts'. It took him many years to muster the courage to raise the issue and request help. He reported numerous difficult holidays always trying to avoid taking off his T-shirt.

Gynaecomastia - after

The patient was referred to a breast surgeon. Rather than the relatively major procedure of mastectomy, he opted for submammary liposuction and was delighted with the results. Although his situation was not due to any underlying condition, there are increasing numbers of male patients with gynaecomastia as a side-effect of hormonal treatment for prostate cancer with LHRH analogues.

Psoriasis - before

Submammary intertrigo is a fairly common complaint. This is usually due to fungal infection affecting areas where the skin is not well ventilated and the protective barrier is broken. The submammary area is also affected by other skin problems, and in this case the diagnosis was psoriasis. This presentation is not as simple as the more widely seen guttate or plaque psoriasis. The more unusual types of psoriasis need to be considered with rashes in areas such as flexures as there is often no other obvious history of psoriasis.

Psoriasis - after

Treatment is usually commenced with a topical antifungal, such as clotrimazole 1%. This is often combined with a topical corticosteroid as this helps reduce the inflammation. Clearly this will not have much of an impact on the psoriasis, though the presence of a steroid may appear to control the rash initially. This patient was treated with a course of betamethasone and calcipotriol and responded very well.

Breast cancer - before

This 47-year-old premenopausal woman presented with a lump in her right breast. She was referred for assessment, and a fine needle aspiration confirmed that the lump was benign, but investigations also revealed a number of areas of suspicious calcification and a mass in the left breast. This was malignant. It was initially felt that a simple lumpectomy might not be a safe option. She did not want to lose her breast however and was very worried about having a mastectomy.

Breast cancer - after

After further explanation and the chance to see images of other patients who had undergone the procedure, she agreed to the recommended treatment option of having a mastectomy followed by a flap reconstruction. The scar is shown clearly and healed well. She was very pleased with the cosmetic result of her surgery.

Tubular breast deformity - before

This 17-year-old girl was very distressed by the asymmetric and somewhat abnormal appearance of her breasts. She had started her periods several years earlier, and the appearance was stable. She was diagnosed as having tubular breast deformity grade 1-2 severity on the right side and grade 3 on the left. Surgical treatment was recommended.

Tubular breast deformity - after

Funding from the PCT was approved and a three-stage procedure undertaken. This consisted of initially having a tissue expander inserted to stretch the tissue by approximately 20ml per week. This was followed by insertion of a silicone implant, with a final stage comprising fat transfer to the lower part using liposuction from the abdomen. The patient was delighted with the end result, which has undoubtedly had a significant effect on her mental well-being as well as her shape.

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