i have this deformity that i really want to get fixed before summer (2011) is over. i originally didnt want implants but have decided that silicone is really the best choice here and i will be much happier with the results this way. is it even possible with my deformity to have "natural" looking breasts? is there anything i can do pre-op that will help my surgery go much smoother? my consultation isnt untill next week but i want as much info as i can get beforehand.
Severe Tubular Breast Augmentation, How Can I Best Prepare For Surgery?
Doctor Answers (11)
Tubular breasts and options for correction
There is more than one treatment for your condition. A silicone implant is the best choice if you desire an implant, however, your breast will look like breast implants, though this is a look many women are looking for today. You can also have fat grafting, but due to your small breast size and depending on whether you want to be significantly larger, you will need several sessions of fat grafting to achieve a larger cup size. A third alternative is to do both an implant and fat grafting. This will likely give you the most natural look in one step. You may still need a peri-areolar lift to correct the nipple, but I would most likely try correcting it without the circumareolar incision at first and perform an in-office additional correction if the first attempt is did not produce sufficient nipple flattening.
Cohesive Gel Implants and Areola Reduction
This type of tubular breast deformity is very severe and it demands a high understanding and experience with this kind of breast deformity. Sometimes there will be a need for 1-2 further more corrections, there are many ways for the correction. In some cases the skin will be prepared with a saline expander ( tissue expansion ) before the implants are placed.
Probably there is good option for cohesive gel implants, for example the gel implants from Allergan ( Natrelle MF or MX ). In the same surgery the areola prolaps will be corrected. It is possible to put the implants thru the areola, so there is no need for another scar. If the augemtation is done before the skin expansion, you should be patient for the final result.
Tubular breast augmentation
You do in fact have a severe form of tubular breast deformity, and although this is not easy to correct, I think that you have a good chance of a significant improvement and a more natural breast contour. You mention that you originally did not want implants. If you are accepting of your current small breast size, the repair is much easier. You would have a periareolar breast lift with an incision around the areola to "telescope" in the areola, make it smaller and less protruding. That alone would give you a significant improvement without the use of implants, although you must accept the small breast size that you currently have.
The difficult part is if you want your breasts to be larger. An implant augmentation is only going to look good if your high, constricted inframammary fold (the crease under your breast) is lowered significantly so that the nipple is not at the bottom of the breast pointing down, and the pocket for the implant is also released towards the center of your chest enough so that your breasts are not so far apart. Unfortunately, if your skin is tight this pocket may not contour well, and the old tight crease just below your areola may persist, giving you a "double crease" or an indentation in the lower pole of your breast. Attempts are made at surgery to "release" any constricting bands and encourage your tight, constricted lower pole to "expand", but there is a limit to how much your tissues will cooperate. Depending on the tightness of your skin and your inframammary fold, you might benefit from a first stage insertion of tissue expanders, which are used to stretch your skin and tissues and release the constriction, followed by a second surgery to replace your expanders with permanent breast implants. Although we do not usually need to use tissue expanders, in more severe cases they can give us the stretching and contour control that we need and improve our results. Either way, you will still require the periareolar "telescoping" lift to reduce the protruding "pseudo-herniation" of your areola. Good luck at your consultation and with your surgery!
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Tuberous breast correction
The goal is to create a more rounded, regular shape and decrease large areola and large nipples, if necessary. Ideal breasts are comprised of evenly distributed tissue while tuberous breasts are characterized by tissue that is concentrated directly underneath the protruding nipples. Because of this, a common treatment technique involves releasing this constricted breast tissue by making internal radial incisions that allow it to splay out properly. These incisions are done internally so the patient doesn't see anything externally. In most cases I will suggest the placement of an implant, typically in the sub-mammary position to better influence the breast’s shape and to add greater volume. If excess or sagging skin is present, surgeons may recommend performing a breast lift as part of the procedure as well. You may need another procedure to address the crease. Please wait about 4 months after surgery to determine this.
There really is nothinhg for you to do prior to surgery for your tuberous breasts to assist surgery. You should avoid blood thinners.
Tubular Breast Correction with Augmentation
The surgical correction of the tubular breast is challenging. It is important to see a board certified plastic surgeon who is experienced in this area and you should prepare yourself by having realistic expectations. A significant problem in the tubular breast is the skin tightness across the lower portion of the breast. This then causes the breast tissue to push out or "herniate" through the areola. Correction involves reducing the fullness of tissue in the areola and expanding the tight skin across the lower pole of the breast. The biggest challenge is expanding the tight skin that did not fully relax and stretch, allowing the natural rounded appearance of the lower portion of the breast. Technically, your surgeon will attempt to release the tight tissues and place an implant. Even in the hands of a skilled plastic surgeon, your breast skin will resist the immediate expansion. This can limit the final result. The size of implant used is limited and recurrence of the breast tightness is a possibility. Revisions may be indicated in the future.
Your plastic surgeon may also discuss with you the option of a staged procedure, which may be a strong consideration. In cases of moderate to severe tubular breasts, a tissue expander is placed at the first operation. This allows for progressive expansion of the skin. Then the final implant is placed months later when adequate softening, expansion and shaping of the breast has occurred.
I hope all goes well for you and that you have a good experience and results that you are happy with.
Behzad Parva, MD, FACS
Tubular Breast Deformity
A tubular breast can be a complex problem and the first step in preparation is to know that you have the most severe form of this problem. This is not a problem that can be solved by the end of the summer. However, with the right procedures and an experienced plastic surgeon you can hope for a great deal of improvement. In my opinion, you will need 2 procedures. In the first the large areola and "herniated" breast tissue behind it would be reduced and a tissue expander inserted below your chest muscle. This device is similar to an unfilled saline breast implant and saline can be gradually added weekly to stretch the skin of your chest wall. At the second stage, the expander would be replaced with a silicone gel breast implant. You may need a third stage to adjust the breast implant position or size and shape of the areola.
Severe Tubular Breast Augmentation, How Can I Best Prepare For Surgery?
You need in detailed evaluations, discussions on the stages of your surgery. In my opinion at least 3 stages will be needed.
Choosing a surgeon
The best things you can do before surgery are:
- see more than one surgeon because your case is not one of the more common ones and choose your surgeon carefully
- make lists of questions to ask at the time of consultation
- make a check list to compare surgeons and good over it carefully before picking one
- follow your surgeons instructions before and after surgery in order to get the optimal result
- make sure the surgeon can set a realistic view of the end result
You can look at the referenced webpage to help you choose a surgeon.
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.
Complex tuberous breasts, expectations, and adjustable saline implants
You have very complex tuberous deformities and you need a very experienced surgeon for the best result, not a rookie and not a fake plastic surgeon ("cosmetic surgeon"). Also, you need to understand that "better" or "improvement" is the proper expectation, not perfect or normal looking. Also, given the complexity of this, don't put time restarints on getting the result.
I would personally advocate an adjustable saline implant, not a gel, because you will get a better result IMO by expanding the tissue over time and with that implant you can choose the final look and size you like best.