Is the external "rigottomies" needle procedure with fat transfer an effective way to improve the appearance of tubular breasts?

There are many variations of tuberous breast deformity and different surgical techniques are used depending on the degree of the deformity. The more severe the deformity, the more aggressive the surgical correction needs to be. I rarely perform a mastopexy at the initial procedure, but rather, allow the breast tissue to stretch and settle before addressing idea of a lift or areolar reduction unless they are overly large initially.

That is one way to do it. Without seeing photos, it is difficult to say.  I usually place implants and open the lower pole as needed.  Depending upon who the areola appears, I sometimes work on that as well.

Analysis of the tuberous breast is 1: high infra-mammary line2: constricted lower pole of the breast, tight skin and lack of breast tissue3: herniated breast tissue in the nipple-areolaThere are many degrees of manifestations of the tuberous breast, degree of the tuberous breast.Mastopexy is rarely, if ever, the answer for correction.Multiple methods have evolved over the years and are well established for the correction of tuberous breast.Lowering the infra-mammary line.releasing the lower pole. This can be achieved by many methods. In severe cases tissue expansion.Some advocate  release of the lower pole by "un-furling' of the lower pole breast tissue.Mild cases can be treated with implants only.Releasing the lower pole by making cuts with a needle in the lower pole of the breast, so called "rigottomies" and filling with fat transfer needs a good scientific study to determine effectiveness of both the "Rigottomies: and the fat transfer.Fat transfer to the breast needs to answer many questions scientifically, 1: how much fat remains2: what effect on mammograms of fat necrosis and oil cysts and microcalcifications3: what is the long term effect of fat cells and stem cells in the breast4: how many fat transfer sessions are needed, Cost?5: can the results be duplicated case after case