It certainly does appear that you have tuberous breasts (type II for what that is worth). Fortunately you have reasonable symmetry (significant asymmetry is not uncommon with tuberous breasts). Implants alone (without a lift) will likely give you a nice result. There are two major problems that must be corrected. First the high/ constricted crease must be lowered appropriately. That can be done during the dissection of the implant pocket. Next there is a deficiency of lower pole skin . If you were to measure from the crease to the bottom of the areola, the distance would be much to short. We depend on the implant to act as an expander and stretch the lower pole skin. By lowering the crease and waiting a few months for the lower pole skin to stretch, we can usually avoid a lift.
So here is my opinion. And obviously you will find, and have found, others. The implant should be larger, rather than smaller. Remember that we want it to stretch the lower pole skin. But it should not be too large because we do not want it to bottom out. 450-500cc does seem about right. I do not think you will need a lift. I do not think you need an anatomical implant. They are textured instead of smooth which brings it's own set of downsides (especially as it becomes attached to the surrounding tissues and hence it may ride too high), and something a little more round would appeal more to me aesthetically.
Finally we do not want the muscle to prevent either the adequate lowering of the crease or the weight of the implant from expanding the lower pole skin. Hence the implant should be either over the muscle (sub-glandular) or sub-muscular with a dual plane (the lower half of the implant is essentially sub-glandular). Total muscle coverage is to be avoided in this situation. The downside of the sub-glandular approach is the increased risk of capsular contracture. A textured implant (which I do not favor as I already have said) or a three month course of Singulair (only anecdotal data) might help with this. The downside of the sub-muscular placement is implant movement with muscle activation and the fact that it takes longer post-op for the final result to be apparent.
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You appear to have a contracted lower pole. Cannot give you choices about size without a proper examination.
In breast augmentation I have chosen to spend time reviewing
photographs with patients to fully understand their expectation of size and
shape. Many times this simply raises
more questions. I will make measurements
and use the implant guides to allow the patient to understand exactly the sizes
that are reasonable for their body type and measurements.
Please find an experienced Board Certified Plastic Surgeon
and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all
aspects of facial surgery, breast augmentation and body procedures including
tummy tucks or mommy makeovers!
You do not have tuberous breasts. Breast implants can improve the appearance
Thank you for your question. You have angular or triangular shaped breasts but fortunately do not have classic tuberous breasts. A sub-mammary breast augmentation with implants will improve the appearance of your breasts. If you want breast implants under the muscle you will need a mastopexy.
Breast Augmentation with Mini Ultimate Breast Lift(TM)
your breasts are tuberous or not, I recommend a new technique called Breast
Augmentation with Mini Ultimate Breast LiftTM. Using only a circumareola incision it is
possible to reshape your breast tissue creating upper pole fullness, elevate
them higher on the chest wall and more medial to increase your cleavage. Through the same incision, implants can be
placed. Aligning the areola, breast
tissue and implant over the bony prominence of the chest wall maximizes
anterior projection with a minimal size implant. Small round textured silicone gel implants
placed retro-pectoral look and feel more natural, are more stable, less likely
to ripple or have complications needing revision. Implant profile is irrelevant in the
retro-pectoral since the muscle compresses it.
This technique avoids the ugly vertical scars of the lollipop and is
more stable than the peri-areolar lift.
Gary Horndeski, M.D.
Do I have tuberous breasts, and what are my options?
I do think that the base of your breasts are slightly narrowed and maybe a bit constricted but I do not think you have tuberous breast deformity which is a congenital abnormality of the breasts. (also known as tubular breasts) Classically you would see very large areola with much of the breast mass herniated into the areola along with a narrow constricted base. I don't see this from the photos. Regardless of the diagnosis, the surgery I would recommend is still augmentation mastopexy. Although I have used many anatomical implants, I have not placed them in combination with a mastopexy so I would defer that part of your question to the other excellent commentators here. Good luck and be safe.
John T. Nguyen, MD, FACS, FICS
Double Board Certified Plastic Surgeon
Anatomic Implants for tuberous breast treatment
Thanks for posting your question and photos
It appears you have a mild to moderate tuberous breast shape. Tuberous breast can vary and it can range from mild to severe. Severe cases will often need tissue expansion, and a staged reconstruction
Based on the photos your case appears mild, and there is reasonably good symmetry. In these cases it is often necessary to lower the inframammary fold and release any tight or constricted breast tissue in the lower breast. I believe the anatomic shaped implants work very well in cases of mild tuberous breasts and they can be placed in a subglandular position to optimize the stretch on the lower pole. Make sure to visit with a board certified plastic surgeon and be comfortable with the surgical plan.
Tuberous breast best treated with shaped implant
Thank you for the question and for providing the photographs. It appears you have a form of tuberous breast. Tuberous breast is a spectrum and it can range from mild to severe. Severe cases need tissue expanstion. Your situation appears fairly mild. As a previous doctor pointed out, your breasts look fairly symmetrical. Some people with tuberous breast have significant asymmetry. Most likely your surgeon will need to lower your inframmary fold level and release any tight tissue. In my opinion tuberous breast patients get the breast result with a subglandular (on top of the muscle) silicone shaped (anatomic) implant. Hope this helps.
Tracy Pfeifer, MD, MS
you don't have tuberous breasts, you just have a high inframammary crease and ptosis of the breast tissue.
You need a submuscular breast implant and a vertical mastopexy.
You do not have a tuberous breasts
Your breasts do not meet the criteria of tuberous breast deformity. You do have sagging. I approach such situations by subglandular silicone breast implants. Size is determined at time of consultation based on your input. Breast lift will be required in your case.
Type of breast lift is determined by assessment of breasts at time of consultation. It also is determined by size of implant that will be used.
You should not be lost in all the name designations of lifts.
Everone needs the lift that does the job of creating a pretty breast.
Thank you for the question.
In my opinion, by placing implants under the muscle will benefit your condition.