- Email: [email protected]
Breast lipofilling: A new treatment of Becker nevus syndrome
+ Models
ANNPLA-1115; No. of Pages 4 Annales de chirurgie plastique esthétique (2015) xxx, xxx—xxx
Available online at
ScienceDirect www.sciencedirect.com
CLINICAL CASE
Breast lipofilling: A new treatment of Becker nevus syndrome Lipofilling du sein : une nouvelle approche pour le traitement du syndrome de Becker C. Ho Quoc a,*,c,1, M. Fakiha b, A. Meruta b, C. Dlimi b, J.M. Piat c, E. Delay b a
Clinique du Val d’Ouest, 39, chemin de la Vernique, 69130 ´Ecully, France ´ on Be ´ rard Center, 28, rue Laennec, 69008 Lyon, France Le c International Breast Institute of Orangerie, 11, rue Silbermann, 67000 Strasbourg, France b
Received 21 June 2014; accepted 2 February 2015
KEYWORDS Becker nevus syndrome; Lipofilling; Fat grafting; Breast hypoplasia; Breast augmentation; Breast asymmetry
Summary Introduction. — The association of Becker’s nevus with other cutaneous, musculoskeletal or maxillofacial anomalies is called Becker nevus syndrome. Ipsilateral breast hypoplasia is the main reason for female patients to seek medical advice. We present two clinical cases of Becker nevus syndrome with thoracic nevus and ipsilateral breast hypoplasia treated with lipofilling alone (fat grafting). Material and methods. — For the two consecutive cases of Becker nevus syndrome treated by fat grafts, we present the surgical technique and the outcome at one year follow-up. Fat was harvested with cannula after infiltration. The adipose tissue was prepared with a short centrifugation. Fat grafting was realized as backward injections. Results. — We have noticed a concomitant improvement of the thoracic nevus color with a stable result after one-year follow-up. The aesthetic result after lipofilling was evaluated as very satisfying by the patient. The breast symmetry was improved. Conclusions. — We believe that the lipofilling technique is a natural and valuable treatment option for thoracic anomalies in Becker nevus syndrome with a major impact on patient’s quality of life. # 2015 Elsevier Masson SAS. All rights reserved.
* Corresponding author. E-mail address: [email protected] (C. Ho Quoc). 1 www.dr-hoquoc.com. http://dx.doi.org/10.1016/j.anplas.2015.02.001 0294-1260/# 2015 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Ho C, et al. Breast lipofilling: A new treatment of Becker nevus syndrome. Ann Chir Plast Esthet (2015), http://dx.doi.org/10.1016/j.anplas.2015.02.001
+ Models
ANNPLA-1115; No. of Pages 4
2
C. Ho Quoc et al.
MOTS CLÉS Syndrome de Becker ; Lipofilling ; Transfert graisseux ; Hypoplasie mammaire ; Augmentation mammaire ; Asymétrie mammaire
Re ´sume ´ Introduction. — L’association du nævus de Becker avec d’autres manifestations cutanées, musculo-squelettiques ou maxillofaciales constituent une anomalie appelée syndrome de Becker. L’hypoplasie mammaire homolatérale est le principal motif de consultation des patientes. Nous présentons deux cas de syndrome de Becker avec nævus thoracique et hypotrophie mammaire homolatérale traités par transfert graisseux seul. Mate´riel et me´thodes. — Pour les deux cas consécutifs de syndrome de Becker, nous avons décrit la technique chirugicale du lipofilling et les résultats au long cours à un an postopératoire. Après prélèvement de la graisse, une courte centrifugation a été réalisée avant de réinjecter la graisse de façon rétrotraçante. Re ´sultats. — Nous avons noté une amélioration de la couleur du nævus de Becker avec un résultat stable à un an post-opératoire. Les résultats esthétiques ont été jugés très satisfaisants par la patiente avec une bonne symétrie mammaire. Conclusions. — Nous pensons que le lipofilling est une technique naturelle et valable pour les maflormations thoraco-mammaires du syndrome de Becker avec une amélioration notable de la qualité de vie des patientes traitées. # 2015 Elsevier Masson SAS. Tous droits réservés.
Introduction Becker nevus syndrome is rare. It is a syndrome described in 1997 and characterized by the presence of a Becker nevus in association with unilateral hypoplasia of breast or other cutaneous, muscular or skeletal defects [1]. Female patients usually seek medical treatment for the thoracic nevus and/or breast hypoplasia and the classic treatment consists of breast augmentation using silicone implants. The results after this technique are usually relatively poor regarding the final shape and volume of the breast. As we have great experience with fat grafting, procedure that was practiced in our department since 1998 for breast reconstruction [2], we have extended the indications of fat grafting to breast asymmetry [3] or acquired breast deformities [4,5]. The purpose of this article is to present the lipofilling as a new treatment option for Becker nevus syndrome.
per minute (500 g). The incisions at the breast level were made using a 18 gauge trocar. The treated fat grafts were injected in the deficit areas of the breast using a 2 mm diameter monoperforated cannula [2] from the deep to superficial layers while retracting the cannula. The subcutaneous strings [4] were released using a 18 gauge trocar. The injection points were closed using a 4-0 fast absorbable suture. The breast is dressed using paraffin gauze. In the liposuction areas, a compressive dressing is applied and is removed five days after surgery.
Results The results of fat grafting for the Becker nevus syndrome treatment are shown by two cases of Becker nevus associating breast hypoplasia.
Case report 1
Materials and methods We present two consecutive cases of Becker nevus syndrome. The patients consulted for breast asymmetry with an important breast hypoplasia. A cutaneous pigmentation at the hypoplasic breast level suggested the Becker nevus syndrome diagnosis. We present the lipofilling or fat grafting as an alternative to improve the Becker nevus syndrome. The results were evaluated at one year after surgery. Complications (infection, hematoma, hemorrhage, fat embolism, pneumothorax) were registered. The patient and surgical team result evaluation were recorded. Every surgical procedure was undertaken under general anesthesia. The technique used implied liposuction in the preoperative established fat areas after infiltration with saline serum and epinephrine (one milligram epinephrine in 500 mL of saline serum). The areas chosen for fat harvesting were for the first session the abdomen and for the second session the thighs and the trochanteric regions. 10 cc LuerLock syringes were attached to a 3.5 mm diameter multiperforated cannula for liposuction. The harvested fat was treated by centrifugation for 20 seconds at 3000 rotations
A 26 years old female patient without co-morbidities, presented with right breast hypotrophy and irregular brownish macula with geographic distribution in the right thoracomammary region. No other associated anomaly detected and no family history found. The clinical diagnosis of Becker nevus syndrome was made. The patient concern was her breast anomaly. This was treated with two sessions of fat grafting with the injection of 144 and 312 cc of adipose cells three months apart. No complication was noted. Result after one year showed the correction of the right breast hypotrophy with excellent result and symmetry (Fig. 1). We noticed the light color of the thoracic nevus after the treatment. The patient and the surgeon were very satisfied. The one-year post-operative mammography and ultra-sound were normal.
Case report 2 A 19 years old female patient came to our office to our office with right breast hypoplasia. No other co-morbidities were recorded. The clinical examination showed a right
Please cite this article in press as: Ho C, et al. Breast lipofilling: A new treatment of Becker nevus syndrome. Ann Chir Plast Esthet (2015), http://dx.doi.org/10.1016/j.anplas.2015.02.001
+ Models
ANNPLA-1115; No. of Pages 4
Breast lipofilling: A new treatment of Becker nevus syndrome
3
Figure 1 Right breast hypoplasia and Becker nevus (A, B, C). Result after two sessions of lipofilling with good breast symmetry and improvement of her nevus (C, D, E).
thoraco-mammary brownish nevus with ipsilateral breast hypoplasia. Her left breast was poetic and mildly hypertrophic. No other musculoskeletal or maxillofacial anomalies were found. The Becker nevus syndrome has been diagnosed. This patient was treated for her breast anomaly in two stages. The first one implied injection of 246 cc fat grafts in the right breast. The second consisted of another right breast lipofilling with 300 cc fat grafts and symetrisation of the contra-lateral breast. No complication was noted. The breast symmetry and a considerable improvement of the
nevus color were observed at the one year follow-up (Fig. 2). The patient and the surgeon were very satisfied.
Discussion Becker nevus syndrome is a rare malformation that was first described by Happle and Koopman in 1997 [1]. It is the association of Becker nevus, a skin lesion characterized by circumscribed hyperpigmentation with an irregular outline
Figure 2 Right breast hypoplasia and thoraco-mammary nevus (A, B, C). Result one year after lipofilling and left breast reduction. We can notice the change in the Becker nevus color (D, E, F). Please cite this article in press as: Ho C, et al. Breast lipofilling: A new treatment of Becker nevus syndrome. Ann Chir Plast Esthet (2015), http://dx.doi.org/10.1016/j.anplas.2015.02.001
+ Models
ANNPLA-1115; No. of Pages 4
4
C. Ho Quoc et al.
and hypertrichosis [6], with unilateral hypoplasia of breast or other cutaneous, muscular or skeletal defects. The skeletal anomalies including for example: scoliosis, spina bifida occulta, pectus excavatum or carinatum, and ipsilateral hypoplasia of a limb [1]. Breast hypotrophy is the most frequent abnomaly reported in female patients [7,8] with a sex ratio of 5:1. It may involve the entire breast or only the nipple and areola [7]. The breast asymmetry correction is classically done using silicone breast implants unilateral or bilateral with different volumes [9]. The results are good at the beginning but because of the patients are young, the evolution may associate several long term complications as capsular contracture, implant rupture or seroma [10—12], life implant screening every five years or implant replacement surgery if major complications appear [13]. Lipofilling technique provides an interesting alternative in the treatment of Becker nevus syndrome associating a breast anomaly. It has many advantages: minimal scar, natural and stable result on the long term (if the weight is stable), after obtaining the final result there is no need for another operation and the radiological surveillance follows the normal screening protocol for the age of the patient [14]. In our patients treated by fat grafting for their breast asymmetry induced by the Becker nevus syndrome, we observed a color amelioration of the nevus at the one-year follow-up. This clinical observation can be considered as an additional advantage of the lipomodelling technique although the mechanism remains unknown. The pigmentary lesion can be treated as a Becker nevus, using laser therapies like: ablative laser [15], Q-switched techniques [16] and fractional resurfacing with varying results [17]. Most of these techniques are moderately effective, the impact of the laser treatment being limited to the pigmentation and not sufficient in case of a Becker nevus syndrome, where these dermatological treatments can be sometimes associated to the corrective surgical procedures.
Conclusion Becker nevus syndrome is a rare disease. The treatment is complex and there is no ideal technique or protocol for the associated abnomalies. We suggested the fat grafting as a different alternative to the classic breast silicone implants usually used in cases of breast deformities associated in the syndrome. The results obtained for our two patients were evaluated as excellent for the volume and shape of the breast, but also provided a clinical improvement of the nevus color. This lead to high satisfaction among our patients with no further treatment required.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.
Funding: No funding was received to assist with the creation of this manuscript. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References [1] Happle R, Koopman RJJ. Becker nevus syndrome. Am J Med Genet 1997;68:357—61. [2] Ho Quoc C, Delay E. Breast reconstruction using autologous fat transplantation. In: Gonzalez E, Rancati A, editors. Oncoplastic Surgery of the Breast: How? When? Why? [in Spanish]. 2014. p. 303—14. Journal Ediciones SA. [3] Ho Quoc C, Delaporte T, Meruta A, La Marca S, Toussoun G, Delay E. Breast asymmetry and pectus excavatum improvement with fat grafting. Aesthet Surg J 2013;33:822—9. [4] Ho Quoc C, Bouguila J, Brun A, Voulliaume D, Comparin JP, Foyatier JL. Surgical treatment of sequelae of deep breast burns: a 25-year experience. Ann Chir Plast Esthet 2012;57: 35—40 [article in French]. [5] Ho Quoc C, Meruta A, La Marca S, Fabiano L, Toussoun G, Delay E. Breast amputation correction of a horse bite using the lipomodeling technique. Aesthet Surg J 2013;33:93—6. [6] Tymen R, Forestier JF, Boutet B, Colomb D. Late Becker’s nevus. One hundred cases. Ann Dermatol Venerol 1981;108: 41—6 [in French]. [7] Danarti R, Konig A, Salhi A, Bittar M, Happle M. Becker’s nevus syndrome revisited. J Am Acad Dermatol 2004;51:965—9. [8] Formicon M, Alsina MM, Mascaro JM, Rivera F. Becker’s nevus and ipsilateral breast hypoplasia: androgen-receptror study in two patients. Arch Dermatol 1992;128:992—3. [9] Gore SM, Lamberty BG. Perthese implant-identical cohesive-gel sizers in breast augmentation: a prospective report on 200 consecutive cases and implications for treatment of breast asymmetry. Aesthet Surg J 2012;32:310—8. [10] Heden P, Bronz G, Elberg JJ, Deraemaecker R, Murphy DK, Slicton A, et al. Long-term safety and effectiveness of style 410 highly cohesive silicone breast implants. Aesthetic Plast Surg 2009;33:430—6. [11] Hall-Findlay EJ. Breast implant complication review: double capsules and late seromas. Plast Reconstr Surg 2011;127:56—66. [12] Communication from the Commission on community and national measures in relation to breast implants. Brussels: Commission of the European Communities; 2001 , COM(2001)666 final. [13] Recomandations of medical follow-up in patients with a mammary implant. Afssaps; 2004 [in French]. [14] Delay E, Streit L, Toussoun G, La Marca S, Ho Quoc C. Lipomodelling: an important advance in breast surgery. Acta Chir Plast 2013;55:34—43. [15] Meesters AA, Wind BS, Kroon MW, Wolkerstorfer A, van der Veen JP, Nieuweboer-Krobotova L, et al. Ablative fractional laser therapy as treatment for Becker nevus: a randomized controlled pilot study. J Am Acad Dermatol 2011;65:1173—9. [16] Raulin C, Schonermark MP, Greve B, Werner S. Q-switched ruby laser treatment of tattoos and benign pigmented skin lesions: a critical review. Ann Plast Surg 1998;41:555—65. [17] Glaich AS, Goldberg LH, Dai T, Kunishige JH, Friedman PM. Fractional resurgaing: a new therapeutic modality for Becker’s nevus. Arch Dermatol 2007;143:1488—90.
Please cite this article in press as: Ho C, et al. Breast lipofilling: A new treatment of Becker nevus syndrome. Ann Chir Plast Esthet (2015), http://dx.doi.org/10.1016/j.anplas.2015.02.001
ANNPLA-1115; No. of Pages 4 Annales de chirurgie plastique esthétique (2015) xxx, xxx—xxx
Available online at
ScienceDirect www.sciencedirect.com
CLINICAL CASE
Breast lipofilling: A new treatment of Becker nevus syndrome Lipofilling du sein : une nouvelle approche pour le traitement du syndrome de Becker C. Ho Quoc a,*,c,1, M. Fakiha b, A. Meruta b, C. Dlimi b, J.M. Piat c, E. Delay b a
Clinique du Val d’Ouest, 39, chemin de la Vernique, 69130 ´Ecully, France ´ on Be ´ rard Center, 28, rue Laennec, 69008 Lyon, France Le c International Breast Institute of Orangerie, 11, rue Silbermann, 67000 Strasbourg, France b
Received 21 June 2014; accepted 2 February 2015
KEYWORDS Becker nevus syndrome; Lipofilling; Fat grafting; Breast hypoplasia; Breast augmentation; Breast asymmetry
Summary Introduction. — The association of Becker’s nevus with other cutaneous, musculoskeletal or maxillofacial anomalies is called Becker nevus syndrome. Ipsilateral breast hypoplasia is the main reason for female patients to seek medical advice. We present two clinical cases of Becker nevus syndrome with thoracic nevus and ipsilateral breast hypoplasia treated with lipofilling alone (fat grafting). Material and methods. — For the two consecutive cases of Becker nevus syndrome treated by fat grafts, we present the surgical technique and the outcome at one year follow-up. Fat was harvested with cannula after infiltration. The adipose tissue was prepared with a short centrifugation. Fat grafting was realized as backward injections. Results. — We have noticed a concomitant improvement of the thoracic nevus color with a stable result after one-year follow-up. The aesthetic result after lipofilling was evaluated as very satisfying by the patient. The breast symmetry was improved. Conclusions. — We believe that the lipofilling technique is a natural and valuable treatment option for thoracic anomalies in Becker nevus syndrome with a major impact on patient’s quality of life. # 2015 Elsevier Masson SAS. All rights reserved.
* Corresponding author. E-mail address: [email protected] (C. Ho Quoc). 1 www.dr-hoquoc.com. http://dx.doi.org/10.1016/j.anplas.2015.02.001 0294-1260/# 2015 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Ho C, et al. Breast lipofilling: A new treatment of Becker nevus syndrome. Ann Chir Plast Esthet (2015), http://dx.doi.org/10.1016/j.anplas.2015.02.001
+ Models
ANNPLA-1115; No. of Pages 4
2
C. Ho Quoc et al.
MOTS CLÉS Syndrome de Becker ; Lipofilling ; Transfert graisseux ; Hypoplasie mammaire ; Augmentation mammaire ; Asymétrie mammaire
Re ´sume ´ Introduction. — L’association du nævus de Becker avec d’autres manifestations cutanées, musculo-squelettiques ou maxillofaciales constituent une anomalie appelée syndrome de Becker. L’hypoplasie mammaire homolatérale est le principal motif de consultation des patientes. Nous présentons deux cas de syndrome de Becker avec nævus thoracique et hypotrophie mammaire homolatérale traités par transfert graisseux seul. Mate´riel et me´thodes. — Pour les deux cas consécutifs de syndrome de Becker, nous avons décrit la technique chirugicale du lipofilling et les résultats au long cours à un an postopératoire. Après prélèvement de la graisse, une courte centrifugation a été réalisée avant de réinjecter la graisse de façon rétrotraçante. Re ´sultats. — Nous avons noté une amélioration de la couleur du nævus de Becker avec un résultat stable à un an post-opératoire. Les résultats esthétiques ont été jugés très satisfaisants par la patiente avec une bonne symétrie mammaire. Conclusions. — Nous pensons que le lipofilling est une technique naturelle et valable pour les maflormations thoraco-mammaires du syndrome de Becker avec une amélioration notable de la qualité de vie des patientes traitées. # 2015 Elsevier Masson SAS. Tous droits réservés.
Introduction Becker nevus syndrome is rare. It is a syndrome described in 1997 and characterized by the presence of a Becker nevus in association with unilateral hypoplasia of breast or other cutaneous, muscular or skeletal defects [1]. Female patients usually seek medical treatment for the thoracic nevus and/or breast hypoplasia and the classic treatment consists of breast augmentation using silicone implants. The results after this technique are usually relatively poor regarding the final shape and volume of the breast. As we have great experience with fat grafting, procedure that was practiced in our department since 1998 for breast reconstruction [2], we have extended the indications of fat grafting to breast asymmetry [3] or acquired breast deformities [4,5]. The purpose of this article is to present the lipofilling as a new treatment option for Becker nevus syndrome.
per minute (500 g). The incisions at the breast level were made using a 18 gauge trocar. The treated fat grafts were injected in the deficit areas of the breast using a 2 mm diameter monoperforated cannula [2] from the deep to superficial layers while retracting the cannula. The subcutaneous strings [4] were released using a 18 gauge trocar. The injection points were closed using a 4-0 fast absorbable suture. The breast is dressed using paraffin gauze. In the liposuction areas, a compressive dressing is applied and is removed five days after surgery.
Results The results of fat grafting for the Becker nevus syndrome treatment are shown by two cases of Becker nevus associating breast hypoplasia.
Case report 1
Materials and methods We present two consecutive cases of Becker nevus syndrome. The patients consulted for breast asymmetry with an important breast hypoplasia. A cutaneous pigmentation at the hypoplasic breast level suggested the Becker nevus syndrome diagnosis. We present the lipofilling or fat grafting as an alternative to improve the Becker nevus syndrome. The results were evaluated at one year after surgery. Complications (infection, hematoma, hemorrhage, fat embolism, pneumothorax) were registered. The patient and surgical team result evaluation were recorded. Every surgical procedure was undertaken under general anesthesia. The technique used implied liposuction in the preoperative established fat areas after infiltration with saline serum and epinephrine (one milligram epinephrine in 500 mL of saline serum). The areas chosen for fat harvesting were for the first session the abdomen and for the second session the thighs and the trochanteric regions. 10 cc LuerLock syringes were attached to a 3.5 mm diameter multiperforated cannula for liposuction. The harvested fat was treated by centrifugation for 20 seconds at 3000 rotations
A 26 years old female patient without co-morbidities, presented with right breast hypotrophy and irregular brownish macula with geographic distribution in the right thoracomammary region. No other associated anomaly detected and no family history found. The clinical diagnosis of Becker nevus syndrome was made. The patient concern was her breast anomaly. This was treated with two sessions of fat grafting with the injection of 144 and 312 cc of adipose cells three months apart. No complication was noted. Result after one year showed the correction of the right breast hypotrophy with excellent result and symmetry (Fig. 1). We noticed the light color of the thoracic nevus after the treatment. The patient and the surgeon were very satisfied. The one-year post-operative mammography and ultra-sound were normal.
Case report 2 A 19 years old female patient came to our office to our office with right breast hypoplasia. No other co-morbidities were recorded. The clinical examination showed a right
Please cite this article in press as: Ho C, et al. Breast lipofilling: A new treatment of Becker nevus syndrome. Ann Chir Plast Esthet (2015), http://dx.doi.org/10.1016/j.anplas.2015.02.001
+ Models
ANNPLA-1115; No. of Pages 4
Breast lipofilling: A new treatment of Becker nevus syndrome
3
Figure 1 Right breast hypoplasia and Becker nevus (A, B, C). Result after two sessions of lipofilling with good breast symmetry and improvement of her nevus (C, D, E).
thoraco-mammary brownish nevus with ipsilateral breast hypoplasia. Her left breast was poetic and mildly hypertrophic. No other musculoskeletal or maxillofacial anomalies were found. The Becker nevus syndrome has been diagnosed. This patient was treated for her breast anomaly in two stages. The first one implied injection of 246 cc fat grafts in the right breast. The second consisted of another right breast lipofilling with 300 cc fat grafts and symetrisation of the contra-lateral breast. No complication was noted. The breast symmetry and a considerable improvement of the
nevus color were observed at the one year follow-up (Fig. 2). The patient and the surgeon were very satisfied.
Discussion Becker nevus syndrome is a rare malformation that was first described by Happle and Koopman in 1997 [1]. It is the association of Becker nevus, a skin lesion characterized by circumscribed hyperpigmentation with an irregular outline
Figure 2 Right breast hypoplasia and thoraco-mammary nevus (A, B, C). Result one year after lipofilling and left breast reduction. We can notice the change in the Becker nevus color (D, E, F). Please cite this article in press as: Ho C, et al. Breast lipofilling: A new treatment of Becker nevus syndrome. Ann Chir Plast Esthet (2015), http://dx.doi.org/10.1016/j.anplas.2015.02.001
+ Models
ANNPLA-1115; No. of Pages 4
4
C. Ho Quoc et al.
and hypertrichosis [6], with unilateral hypoplasia of breast or other cutaneous, muscular or skeletal defects. The skeletal anomalies including for example: scoliosis, spina bifida occulta, pectus excavatum or carinatum, and ipsilateral hypoplasia of a limb [1]. Breast hypotrophy is the most frequent abnomaly reported in female patients [7,8] with a sex ratio of 5:1. It may involve the entire breast or only the nipple and areola [7]. The breast asymmetry correction is classically done using silicone breast implants unilateral or bilateral with different volumes [9]. The results are good at the beginning but because of the patients are young, the evolution may associate several long term complications as capsular contracture, implant rupture or seroma [10—12], life implant screening every five years or implant replacement surgery if major complications appear [13]. Lipofilling technique provides an interesting alternative in the treatment of Becker nevus syndrome associating a breast anomaly. It has many advantages: minimal scar, natural and stable result on the long term (if the weight is stable), after obtaining the final result there is no need for another operation and the radiological surveillance follows the normal screening protocol for the age of the patient [14]. In our patients treated by fat grafting for their breast asymmetry induced by the Becker nevus syndrome, we observed a color amelioration of the nevus at the one-year follow-up. This clinical observation can be considered as an additional advantage of the lipomodelling technique although the mechanism remains unknown. The pigmentary lesion can be treated as a Becker nevus, using laser therapies like: ablative laser [15], Q-switched techniques [16] and fractional resurfacing with varying results [17]. Most of these techniques are moderately effective, the impact of the laser treatment being limited to the pigmentation and not sufficient in case of a Becker nevus syndrome, where these dermatological treatments can be sometimes associated to the corrective surgical procedures.
Conclusion Becker nevus syndrome is a rare disease. The treatment is complex and there is no ideal technique or protocol for the associated abnomalies. We suggested the fat grafting as a different alternative to the classic breast silicone implants usually used in cases of breast deformities associated in the syndrome. The results obtained for our two patients were evaluated as excellent for the volume and shape of the breast, but also provided a clinical improvement of the nevus color. This lead to high satisfaction among our patients with no further treatment required.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.
Funding: No funding was received to assist with the creation of this manuscript. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References [1] Happle R, Koopman RJJ. Becker nevus syndrome. Am J Med Genet 1997;68:357—61. [2] Ho Quoc C, Delay E. Breast reconstruction using autologous fat transplantation. In: Gonzalez E, Rancati A, editors. Oncoplastic Surgery of the Breast: How? When? Why? [in Spanish]. 2014. p. 303—14. Journal Ediciones SA. [3] Ho Quoc C, Delaporte T, Meruta A, La Marca S, Toussoun G, Delay E. Breast asymmetry and pectus excavatum improvement with fat grafting. Aesthet Surg J 2013;33:822—9. [4] Ho Quoc C, Bouguila J, Brun A, Voulliaume D, Comparin JP, Foyatier JL. Surgical treatment of sequelae of deep breast burns: a 25-year experience. Ann Chir Plast Esthet 2012;57: 35—40 [article in French]. [5] Ho Quoc C, Meruta A, La Marca S, Fabiano L, Toussoun G, Delay E. Breast amputation correction of a horse bite using the lipomodeling technique. Aesthet Surg J 2013;33:93—6. [6] Tymen R, Forestier JF, Boutet B, Colomb D. Late Becker’s nevus. One hundred cases. Ann Dermatol Venerol 1981;108: 41—6 [in French]. [7] Danarti R, Konig A, Salhi A, Bittar M, Happle M. Becker’s nevus syndrome revisited. J Am Acad Dermatol 2004;51:965—9. [8] Formicon M, Alsina MM, Mascaro JM, Rivera F. Becker’s nevus and ipsilateral breast hypoplasia: androgen-receptror study in two patients. Arch Dermatol 1992;128:992—3. [9] Gore SM, Lamberty BG. Perthese implant-identical cohesive-gel sizers in breast augmentation: a prospective report on 200 consecutive cases and implications for treatment of breast asymmetry. Aesthet Surg J 2012;32:310—8. [10] Heden P, Bronz G, Elberg JJ, Deraemaecker R, Murphy DK, Slicton A, et al. Long-term safety and effectiveness of style 410 highly cohesive silicone breast implants. Aesthetic Plast Surg 2009;33:430—6. [11] Hall-Findlay EJ. Breast implant complication review: double capsules and late seromas. Plast Reconstr Surg 2011;127:56—66. [12] Communication from the Commission on community and national measures in relation to breast implants. Brussels: Commission of the European Communities; 2001 , COM(2001)666 final. [13] Recomandations of medical follow-up in patients with a mammary implant. Afssaps; 2004 [in French]. [14] Delay E, Streit L, Toussoun G, La Marca S, Ho Quoc C. Lipomodelling: an important advance in breast surgery. Acta Chir Plast 2013;55:34—43. [15] Meesters AA, Wind BS, Kroon MW, Wolkerstorfer A, van der Veen JP, Nieuweboer-Krobotova L, et al. Ablative fractional laser therapy as treatment for Becker nevus: a randomized controlled pilot study. J Am Acad Dermatol 2011;65:1173—9. [16] Raulin C, Schonermark MP, Greve B, Werner S. Q-switched ruby laser treatment of tattoos and benign pigmented skin lesions: a critical review. Ann Plast Surg 1998;41:555—65. [17] Glaich AS, Goldberg LH, Dai T, Kunishige JH, Friedman PM. Fractional resurgaing: a new therapeutic modality for Becker’s nevus. Arch Dermatol 2007;143:1488—90.
Please cite this article in press as: Ho C, et al. Breast lipofilling: A new treatment of Becker nevus syndrome. Ann Chir Plast Esthet (2015), http://dx.doi.org/10.1016/j.anplas.2015.02.001