WHAT IS THE TRADITIONAL CLASSIFICATION OF THE TUBEROUS OR TUBULAR BREAST DEFORMITY? | There is a traditional and very limited classification, by Grolleau et al, who speaks about three degrees; Grade I | The lack of development is limited to the inferior-internal quadrant, the areola is deflected downwards and inwards, being the volume of the breast normal or hypertrophic; Grade II | The two lower quadrants are deficient in their development, in these cases the areola is deflected facing downwards; Grade III | All quadrants are affected and are deficient, the mammary base is retracted and the breast has a caprine or tubercle look.
DR. ALEJANDRO NOGUEIRA'S CLASSIFICATION OF THE TUBEROUS OR TUBULAR BREAST DEFORMITY | Given the polymorphism of the tuberous or tubular breasts and their different clinical aspects, based on his own personal experience Dr. Alejandro Nogueira proposes a new classification of tuberous or tubular breast he has designed, developed and applied, taking into account the different signs in a more detailed and organized manner, providing a therapeutic-clinical-prognostic approach with medico-legal perspectives.
CLINICAL PARAMETERS | In Dr. Alejandro Nogueira's classification the following parameters are taken into account with their corresponding gradation according to the anatomical and clinical features of the tuberous or tubular breast deformity.
Conicity (C) | The greater or lesser constriction of the breast cone | C0: none, no constriction, can have tuberous or tubular texture | C1: mild, one constrained quadrant | C2: moderate, two quadrants constrained | C3: severe, three quadrants constrained | C4: extreme, four quadrants constrained.
Areola (A) | Hypertrophy suffered by the areolar skin of the largest areola according to the anatomical proportions of the patient, measured as the radius gap between the outer areolar perimeter and the optimal one planned | A0: none, normal or hypoplastic areola | A1: mild, areola hypertrophied 1 cm | A2: moderate, areola hypertrophied 2 cm | A3: severe, areola hypertrophied 3 cm | A4: extreme, areola hypertrophied 4 cm.
Hernia (H) | The reducibility and shape memory of the areolar hernia | H0: none, no hernia or only manually provoked | H1: mild, reducible hernia with areolar contraction | H2: moderate, reducible hernia with underwear | H3: severe, manually reducible hernia | H4: extreme, irreducible hernia.
Submammary fold (F) | Downwards displacement from the original one the patient was born with necessary to achieve lower pole reconstruction and breast implant centricity | F0: in situ, without displacement, may require descent if there is an implant | F1: mild, displacement lesser than 2 cm | F2: moderate, displacement from 2 to 4 cm | F3: severe, displacement from 4 to 6 cm | F4: extreme, displacement larger than 6 cm.
Skin (S) | Neo lower pole, previously upper abdominal terrain, skin firmness | S0: none, flaccid | S1: mild, normal | S2: moderate, hard | S3: severe, very hard | S4: extreme, cuirass.
Associated problems (As) | Breast abnormalities, problems or issues, other than lack of development or breast hypoplasia, which require surgical correction at the same time than the tuberous or tubular breast deformity like pathological breast asymmetry, breast droopiness or mammary ptosis, breast hypertrophy or gigantomastia, previous breast surgeries, failed attempts of tuberous correction, presence of failed or ruptured breast implants and others | As0: none, no increase of complexity | As1: 1, mild increase of complexity | AS2: 2, moderate increase of complexity | As3: 3, severe increase of complexity | AS4: 4 or more, extreme increase of complexity.
GRADATION OF TUBEROSITY | Based on the previously classified clinical parameters the prognostic gradation and severity of the tuberous or tubular breast deformity is defined, combining them in different degrees of tuberous or tubular breast.
Tuberous or tubular breast grade 0 (trait): C0 + A0/1 + H0/1 + F0 + S0/1 | Tuberous or tubular breast grade I (mild): any combination with C1 or A2 or H2 or F1 | Tuberous or tubular breast grade II (moderate): any combination with C2 or A3 or H3 or F2 or S2 | Tuberous or tubular breast grade III (severe): any combination with C3 or A4 or H4 or F3 or S3 | Tuberous or tubular breast grade IV (extreme): any combination C4 or F4 or S4 | Complicated tuberous or tubular breast (X): any grade with As1/2/3/4.
SURGICAL RISK OF TUBEROSITY | A generic treatment prognosis criterion is concluded from this classification in terms of rates of complications and likelihood of a reoperation. These are overall percentages in an ideal scenario safe from the typical surgical complications, involving highly adherent implants, enjoying a well trained surgeon and done on strictly collaborative patients.
Very low risk (5%): grade 0 | Low risk (10%): grades I and II | Medium risk (15%): grade III or grades 0/I/II-X | High risk (20%): grade IV or grade III-X | Very high risk (25%): grade IV-X.
To these percentages has to be added another 25% probability of poor result and reintervention when poorly adherent implants are used and an additional 25% in case the surgeon is not experienced in tuberous or tubular breast treatment techniques. An extra 10% risk would source from any usual postoperative complication, including non compliant patient of postoperative immobility.
This series of tuberous or tubular breast patients depicts different configurations of the deformity so that the polymorphism of this congenital abnormality is shown; each case has been tagged following Dr. Alejandro Nogueira's classification for a better understanding how it works and aiming to provide the surgical prognosis of each case.
Due to the competitiveness scenario of the markets most plastic surgery clinics and plastic surgeons feel forced to invest large sums of money into advertising and marketing campaigns; this non medical additional cost is always and necessarily charged on top of the final price paid by patients, leading thus to an overprice of surgeries and treatments. No one patient wishes to bear that financial burden embedded in the surgical costs, furthermore neither surgeons nor clinics are happy to increase their retail prices and penalize their customers with costs not bringing any kind of special medical benefit, safety enhancements or results improvement; the promotion budget aims only to disseminate the public knowledge of a services provider and raise the awareness about its presence to potential customers, but not to make the service or the product a better one.
Seems like this model is a no-way-out labyrinth from which no one can be freed, furthermore it is such a tempting, easy and hassle-free way that actually most patients and plastic surgery providers are locked into it, happily or with resignation, paying a high price due to being non collaborative; however there is an ideal alternative, based on keeping up a good hard work based on a strive for providing quality service and achieving patients' satisfaction, which necessarily requires the decided support of the clients and somehow their involvement in such virtuous business model grounded on top-notch results
When plastic surgery providers and patients do actively engage into a collaborative economy scenario a win-win basis is set for their relationship, since the clinics and surgeons obtain the best promotion ever possible with no budget for marketing investment and the patients get in return rid of any additional and unnecessary costs; such a price reduction does not represent any loss in the quality of the treatment they are receiving, furthermore this saving achieved will actually reward customers with a reinforced confidence and guarantee the service providers will strive to perform the best job possible and obtain results second to none.
It is not a paradox or contradiction; under a collaborative economy umbrella plastic surgery patients enjoy a greater plus of confidence that clinics and surgeons will do their very best and beyond to satisfy their customers, in spite the price is lower than in marketing-based non collaborative models; plastic surgery providers who found their business sustainability on the pillars of exclusively or mainly incremental budget investment in ongoing promotion campaigns do have little incentive in achieving first-class results and the best patient experiences, since their business model is not based on returning patients after word-of-mouth dissemination of their reputation but on the attraction of cold clients with sophisticated advertising methods of higher or lesser moral acceptability, attracting customers as parachutists randomly landing on unknown land, which is a perverse business model frequently leading to an unavoidable degradation of safety and results quality besides an uncontrollable increase in costs and prices; this marketing-based model creates no incentives to keep up the good work and pushes the prices higher on and on due to require increasing promotional investments.
On the other side, which is definitely our side, clinics and surgeons who rely solely or mostly their existence and survival in the competitive plastic surgery market enjoying the widespread of their excellence extended by their own patients results and satisfaction, like a mill driven by the winds of prestige, have the strongest ever incentive to be the best service providers around, sourced from the support of happy clients and their operated cases as proof of their excellent jobs; needless to say such supporters, the patients, have to enjoy a share of this benefit so that the incentive is reciprocal; under this scenario clinics and surgeons strive to provide the best service and accordingly patients release and transfer in a fair exchange the materials and tools required to build a marketing-budget-free and virtuous business model which creates the perfect incentives to build the best sponsorship-free reputation, based on the grounds of medical quality thus allowing prices control within affordability thanks to the minimal cost of its maintenance.
This is the deal; patients give in our favor the release and transfer of the intellectual property, the rights of image, the medical records and the personal data of their cases for scientific dissemination, medical teaching, public communication, commercial promotion, advertising marketing, commercial exploitation and disclosure in general, and they receive in exchange a compensating remuneration of a -20% discount from the standard price list for our treatments, as it is publicly visible by default in all the prices and quotations on our website.
As can be observed our visible prices are highly competitive if compared with other plastic surgery providers, actually the difference is approximately a -20% from the average price of each particular treatment in other clinics and surgeons from similar economical areas and countries of comparable development; this is not due to any quality or safety downgrading but to our collaborative business model; in other words, the budget which theoretically should be invested in marketing and promotion campaigns is discounted from the retail prices and, unlike other plastic surgery providers, is not wasted into pointless advertising to patients which entails no kind of added value for them; such campaigns are replaced with our superb results publicized thanks our patients support by letting us use their cases' Before & After and Intraoperative & Technical images and medical details; this explains that price gap between us and other clinics and surgeons.
Print screen alert
You attempted an unauthorized action. All contents of this site are private and protected. Print screen are not allowed. We have reported with your data location to prevent any ilegal action against the protected contents of this website.