Amastia: Means no breast. This becomes apparent only during the adolescence(late teens), when it is expected to develop/ grow. There is only one answer to this problem ie Breast augmentation with silicon implant or Becker expander implants. may be in future we would have tissue engineered products for use

Poland's syndrome: A rare birth defect charectorised by absence of one side breast and underlying muscles may or may not be associated with hand anomalies. This congenital condition has range of birth defects limited to one side chest and upper limb. Hence the treatment customised to individual case depending on its severity of anomaly. The timing of individual corrective procedures is also very important. For example hand anomalies requires early intervention in preschool age, where as breast reconstruction is scheduled after the adolescent growth spurt.

Supernumery nipples: Babies born with condition are rare and have multiple nipples distributed along the milk line. These additional nipples may or may not have rudimentatary breast tissue under them. The only solution is surgical removal in a aesthetic manner. this is a simple surgical exercise.

Accessary Breasts: Relatively common birth anomaly of breast that present during adolescence (late teens). these additional breasts are usually located in the armpit and making it a trouble some lump under the arms often adds to the agony during periods. There are three ways of removing this additional breast. These are open technique that leaves long scar, Liposuction that may or may not completely remove it and endoscopic technique, which allows complete removal through couple of keyholes.

Hypo plastic breasts: Underdeveloped breasts resulting in disproportionately small breast that mismatches with the rest of the body. Answer is again very simple i e Breast augmentation with silicon breast implant.

Asymmetry of breasts: Symmetry (equality) is an issue with any paired organs for that matter. Majority of female population have a minor degree of asymmetry of breasts. So it is not an issue to seek attention unless the difference is obvious and bra cup mismatch is apparent. After pregnancy the difference also grows bigger not only the size, but in shape and level of nipples.

Tubular Breast
Unfortunately this condition is the most absurd of all the anomalies and also complex to treat. The underlying pathology of this deformity is constricted breast base and herniation breast through areolar ring. this condition is often associated with some degree of hypoplasia.

Enlargement of breasts are achieved by inserting an appropriate size and type of implant under breast tissue or chest muscles through a 4 to 5 cm long incision under the breast. There are other approaches such as armpit and umbilicus, which leave hidden, scars.

The four major achievements with this procedure are Reduction in weight of the breast, reduction in the size, relocation of nipple to its late teen location and reduction of the areola to its youth diameter of about 4 to 5 cm.

The resulting scar is place under the breast as an inverted T. These scars include a vertical segment of about 4 to 6 cm extending from lower areolar border above to join the horizontal segment along the crease under the breast.

With age & gravity working on any projecting organ descends down naturally. Some have significant glandular involution/atrophy which results in emptying of breast content which accelerates this process of descent prematurely at an early age. This would some times profoundly affect the sexual life.

The resulting scars will be similar to what described for Breast reduction.

There are various methods in practice to reconstruct the breasts that are removed to control or eliminate the breast cancer. The removal of breast could be partial or total and it could be one side or both depending on the type and stage of cancer presentation. In the modern world, excellent control rates are achieved through early diagnosis & Multidisciplinary approach. In the west, reconstruction has become a part of every breast cancer case management plan. However there is an intensive debate whether to do the reconstruction at the same operation as removal of breast or at a later date. In India, due to lack awareness about the availability of such reconstructive options leaves many patients with no option but to live with it.

Now the desired shape of breast can be achieved even after complete removal of breast. Options are
1) Implant only
2) Becker expander implant only
3) either of the above with Pedicled Lattisimus Dorsi-LD(Back muscle) flap
4) Pedicled Extended LD(back) flap
5) Pedicled Transeverse Rectus Abdominus Muscle(TRAM) flap
6) Pedicled TDAP(Back) flap
7) Free TRAM(Tummy) flap
8) Free DIEP(Tummy) flap
9) free SGAP (Buttock) flap and
10) free IGAP(Buttock fold) flap

Of this range of options, Free DIEP(Tummy tuck) flap is gaining popularity in all the leading centres across the world and being slow in Indian practice. DIEP flap has become a preferred option because of its many merits over the other options. The merits are 1) allows aesthetic breast mound, 2) leaves no defect or weakness at the donor site (tummy), 3) No change of position during operation, 4) two teams can work simultaneously, and 5) most of the patients are also delighted to have the result of tummy tuck operation at the same time.