I've seen 3 doctors with 3 different opinions! My 1st consult the dr told me a have tuberous breasts. He recommended i have a periareolar mastopexy along with the implants, 400CC mod prof. He said it would give me the round shape i desire by moving my nipple up and reducing the size of the nipple a bit. 2nd dr said i didnt need a lift-just implants, and said not to go over 350cc. 3rd dr said my breasts are tuberous, but that implants w/o the lift should be fine, recommended 475cc high profile...
Do I Have Tuberous Breasts and Can I Get Implants Without a Lift? (Photos)
Doctor Answers (15)
Tuberous breasts- avoiding scars and attaining a natural shape
It appears from your pictures that you do have very mild tuberous breasts. The recognition of this diagnosis is very important in your treatment! If proper recognition and planning dont take place you will be at very high risk for asymmetries, widely separated breasts and double bubble deformity especially on your right breast. The features of your breast which give this diagnosis are:
1.) High and tight inframammary fold R>L
2.) Extremely narrow breasts
3.) Wide areolas with herniation on the right
I developed a special modification of technique to suit tuberous breast deformity and use the same technique in mild cases such as yours. A submuscular or dual plane approach will almost certainly draw more attention to the large space between your breasts. A subglandular approach is not likely to remain aesthetically acceptable for very long. I use a technique that I call COLD-SUBFASCIAL augmentation. It is my adaptation of subfascial augmentation that was developed by the world reknowned Dr. Ruth Graf. I use the subfascial plane to create the exact shape needed to close the distance between the breasts, create a nice lateral curvature and upper pole fullness. By preparing the fascia without heat or burning and taking time to preserve all of the fascia, I provide long term internal support to the breasts. The great news is that in your case the entire procedure can likely be completed without any noticible scars. in tuberous breast deformity I am able to reduce the areolas and get 1-2cm of lift with hidden scars( you certainly do not need any more than 2cm of lift). As far as implants, avoid high profile! In breasts such as yours, getting the appropriate width to have a natural shape is much more important!
I would strongly recommend sticking to TRUE subfascial placement and avoid any kind of anchor scar as there is no reason for this in your case. I hope this helps!
All the best,
Rian A. Maercks M.D.
Breast implants without a lift
No, from the pictures you included, it does not appear to me that you have tuberous breasts.
I do not think that a lift is mandatory either
A standard breast augmentation with an implant size of your choice would likely give you the result you are looking for.
You do have a narrow base diameter to your breasts. Choosing the right diameter of implant is going to be a key component to getting you a good result.
I hope this helps. Good luck.
From your photos it does not look like you have tuberous breasts: the bases are wider than the tips. The breasts are widely spaced on your chest and your figure would definitley have improved proportionality with an increase in volume.
Adding implants will increase the diameter of your areolae, so a peri-areolar skin reduction would not be a bad idea. I would suggest the areolar reduction in concert with augmentation using gel silicone implants, moderate plus profile, placed under the breast (on top of the muscle). You can expect an excellent result with improved cleavage.
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Although tuberous breasts vary with respect to severity, a true tuberous breast will have a tubular-shaped breast with a high, narrow breast base, sagging and bulging of breast tissue behind an enlarged areola. You may get some different opinions, but I don't think you have it. You will do well with a breast augmentation alone. The only reason to do a lift would be to reduce the size of the areolas (periareolar mastopexy) if that is important to you. Regarding the size, you have been given a wide range of recommendations. The implant size depends on your goals (make sure you have a "sizing session" with real implants), but it is limited by the amount of available skin and width of the breast base. It is hard to estimate without the benefit of an exam, but base on your photos, I would think that around 350cc would be the right size for you.
Tuberous breasts/ challenging breast augmentation
I agree with those who feel you have a mild tendency toward tuberous breasts but probably don't meet the criteria. Your case is challenging with larger areolar complexes and very wide spacing between your breasts. However, plastic surgeons see such challenges quite often.
As in all cases, your satisfaction will depend on clear communication and realistic expectation. I believe you can have attractive breast but you must make some decisions in regard to nipple position, nipple/areolar size, acceptable width between breasts, overall size, etc...
Many breast augmentations are simple and straightforward, but yours is not, However if you find a good surgeon that can communicate well and you have realistic expectations, I see no reason why you can not be pleased with your results.
Breast augmentation -getting it right the first time
It is impossible to make an appropriate recommendation based solely on the photos you submitted as your holding the camera with your right hand distorts your right breast position. It is hard to see whether the inframammary folds are at different levels or the breasts asymmetric. The first photo does not look like tuberous breasts. The second is shot at an angle that makes them look tuberous. I do not know if you need adjustment of the nipple areola size based on these photos however you need to be careful in choosing that option because the tension of implants behind such a procedure can make the scar widen and/or stretch the areola.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
The reason for so much confusion is that you are a mild case. I don't think you meet the criterion for a tuberous breast but you do have an elongated shape and wide distance between the breasts. I think you would benefit from an augmentation and since your areolae is wider to start, you would likely benefit from a tightening procedure to help improve the shape and appearance of your breasts overall. Just remember that since your nipples are on the verge of needing a lift at the moment, it will not get better with time. Consider doing all of this at once, but this is a decision that can be made by your surgeon during the time of surgery. Sometimes, there is no way to predict the outcome, and it may be that is a decision left to your surgeon.
Best of luck
Vincent Marin, MD
San Diego Plastic Surgeon
I would offer breast implants without a lift
The pictures look like most patients interested in breast augmentation. The breast pictures show a somewhat narrow base diamter breast with slight lower pole constriction. A truly tuberous breast also has "pseudo-herniation" of the breast tissue through the areola. The pictures do not show a tuberous breast. A breast augmentation alone should give a nice result. Yes, the areola will enlarge as a result of the augmentation but I doubt that would be a concern. If it was a problem afterwards it could always be adjusted and a lift could be done at a later date, but to commit to a scar around the areola from the beginning does not seem necessary to me. I would also offer a sub-muscular augmentation but I would use the dual-plane approach. "Dual-plane" breast augmenation refers to a technique in which the breast gland is separated from the muscle in order to maintain the benefits of submuscular implant placement (a more natural upper pole of the breast) with subglandular placement (stretching out the lower pole tissue). As far a sizes, that really depends on the look you are interested in. Your surgeon should listen to your expectations and help in selecting an implant that will accomplish your goals safely. Good luck!
You do not have tubular breast
You have constricted breast an implant will give you larger breast with the need for the lift. The main concern is the space between your breast and you will have gap between your implants. i would agree with your surgeon that recommended 350 cc.
You can get implants without a lift
You do not have a tuberous breast, and you should do quite well with breast implants without a lift. All the differing opinions are confusing, and often can be an issue of aesthetics in what the surgeon feels looks best. You should review the website of all and check photos to see if you like what is there. Also the surgeon might ask what you think is best, can you accept a scar, do you really want a high profile implant, how full, etc. Bring pictures of what you like and what you want to look like, and go with someone who is listening.
Best of luck,
Web reference: http://www.peterejohnsonmd.com
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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