Surgeons with expertise in this area, please provide your thoughts. I would prefer a natural look, so perhaps tear drop would be best?
Suggested Procedure for Tuberous Breasts
Doctor Answers (21)
A two-fold approach to your tuberous breasts
My approach to the tuberous component in your breasts, which I have used in many cases, is twofold.
Initially, through a periareolar incision, I would perform a dual plane augmentation releasing the tight and constricted inferior pole (re: the lower portion of your breasts). This allows the prosthesis to sit lower on the chest and creates a slight upward rotation of the nipple areola. The 2nd part of the procedure is a periareolar mastopexy which allows for diminution in the size of the nipple areolar complex and improvement in the herniated subareolar tissue, particularly on the right side.
Complete correction can be achieved in one operation with an excellent aesthetic result. The periareolar incision should heal quite well since there is not a great deal of elevation involved to cause tension. I prefer to use silicone implants and certainly would not use an anatomic or tear dropped style prosthesis.
Please see the case linked to below for an example of the above. Hope this helps and good luck with whatever you decide to do.
Tuberous breasts: There is a solution!!!
Tuberous breast repairs are commonly scar ridden flat and unnatural looking. The good news is that there is a specific technique to create natural appearing breasts with hidden scars for this type of breast shape. The procedure involves a special subfascial placement of silicone implants and a special nipple lift and areolar reduction with a hidden scar. The results are very natural appearing.
All the best,
Rian A. Maercks M.D.
Tuberous breast correction
There are many different variants of tuberous breast or constricted breast developmental deformities. You do have a variant of tuberous breast, with some areolar protrusion ("pseudoherniation" of the areola), and a very short distance from your nipple to the inframammary fold with deficient tissue in the lower pole of the breast. You also have a rather wide distance between your breasts. You can benefit from a breast augmentation, but it should be performed by a surgeon experienced in dealing with turberous breasts. Your inframammary folds will need to be lowered (otherwise the nipples will be too low on the breast and be downpointing), and the tight "constricted" lower pole of the breast will need to be "released" by some scoring incisions on the undersurface of the breast tissue to allow it to expand under the weight of the implant. The protrusion of the areola that you have will benefit from a periareolar "telescoping" excision similar to a periareolar lift, leaving a scar surrounding each areola and helping to flatten the areola.
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there are many ways to improve the appearance of a tuberous breast. I believe that a periareolar mastopexy or tuck will flatten the "tuberous portion" at the time of augmentation. In addition while dissecting the pocket for the silicone implants, the bands of tissue that are causing this can be released allowing the breast to expand and become rounder. I believe that the implants should be place beneath the muscle. On the right side you may also require an extension of the scar around the areolar making it into more of a lollypop shape.
Web reference: http://www.drrickrosen.com/breast-augmentation-connecticut/
Tuberous breast correction
There is no consensus on the best surgical treatment for tuberous breasts. I personally prefer silicone implants performed through a peri-areolar incision, with a reduction of the areolae and submuscular placement of the implants. Teardrop implants are great, but silicone teardrops are not yet available in the US for general use. I agree with Dr. Rand, however, in that you should expect a significant improvement, but not perfection, as tuberous breasts are extremely challenging to correct. Best wishes, /nsn.
Treating tuberous breasts
You can achieve a nice improvement, not perfection, from your slightly more difficult starting point than some tuberous breasts. You would need periareolar lifts, and in my practice, I believe that an expandable saline implant will give you the best result placed under the muscle because you can stretch the tissues gradually adding fluid after surgery and can best correct the asymmetry and you also get to control the final size you like best.
Tuberous Breasts have a very narrow base and usually a long skin envelope. In the most severe cases of Tuberous Breast, a breast lift can be done through an incision around the areola, making the breast into a more rounded shape that the patient will be happy with. In many cases however, a lift is not necessary. The patient should be aware that the final result will take months to see and that they will need to be patient.
Generally, the procedure involves breast augmentation with areola reduction / mastopexy procedure. The distance from the inframammary fold is increased(to show a more rounded out appearance).
On this site, I do my best to give advice without a physical examination but I want you to know that a physical examination by a board certified physician is always the best way to get the most accurate information.
Suggested Procedure for Tuberous Breast
For your particular case, I recommend a one-stage procedure in which implants are placed under the muscle. I do prefer silicone for appropriate patients because they feel more natural and based on the measurements of the breast, they may be high profile. The other essential steps are reducing the nipple-areola where tissue is protruding out via a peri-areolar lift and releasing the tight constricted bands that are limiting the growth of the breast.
I would not recommend a tear-drop implant because these have the possibility of rotation and malposition.
On the East Coast, I have had several patients travel from NJ, West Virginia, and North Carolina to our office in DC for just this type of procedure.
Tuberous Breasts Augmentation
Like many cases in the world of plastic surgery, tuberous breast can be treated by several different surgical techniques. Essentially the goals are to expand out the tight skin envelope of the breast, relax the conical shape of the breast tissue, and finally reduce the enlarged ("herniated") areola. Depending upon the severity, all this can be accomplished in a single operation for mild-moderate cases or more safely/reliably done in a series of two operations for severe cases. I recommend consulting with a board certified plastic surgeon for a direct physical exam and recommendation to follow. Best of luck...RAS
Surgery for tuberous breasts
Your posted photos show a constricted base of the right breast with a narrow tube like projection of the breast outward/forward from this base. The fold under the right breast is high and the areola is large/stretched out. On the left there is little breast tissue and no fold under the breast to speak of. The left nipple is also further from the midline than the right nipple. The tuberous nature of your breasts and significant asymmetry between your breasts make your case a very difficult one to correct. You need to be very cautious going forward.
If you just put implants in and do nothing else the result will be disastrous. On the right side the base or undersurface of the breast tissue needs to be widened. This can be done by cutting a cross pattern in the base and separating the cut edges. The fold will need to be lowered by releasing the current one and placing sutures to create a new one. The areola diameter is then reduced and your implant placed in position. If you just put an implant in on the right without these other maneuvers it will be too high because the fold is high and there would be a tube of breast tissue narrower than the implant sitting on top of the implant. The left side requires less work because there is less breast tissue that requires correction. On this side your surgeon can get by by making barrel stave like cuts in the lower half of the breast that radiate outward from the nipple area like spokes on a wheel.
With respect to a choice of implant there is nothing special in the tear drop anatomical shaped implants. When they first came out the manufacturers touted their more natural appearance until it was proven that the round implants were tear drop shaped when standing and round while lying flat which is the way natural breasts behave. The tear drop shaped implants remained tear drop shaped when lying flat or standing. Furthermore if the teardrop implant rotates in position you will need additional surgery to replace or reposition it. The round implant is symmetric to its center so if it rotates it does not matter as the breast retains its shape.
In your case because of the degree of breast tissue asymmetry it would be best to use an adjustable implant so it can be adjusted during and/or after surgery. That would mean either saline or a Becker saline/silicone combined implant. That will be the easiest way to end up with similar sized breasts.
Your nipples are currently not symmetric to the midline so the surgery will require removal of some skin next to the areola to adjust the nipple position.
This is a lot of surgery so you have to be very careful about maintaining the blood supply to the nipple during surgery as a good result with a dead nipple will not really be good.
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.
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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