Hi I'm 19 years old, 5'5, 125 lbs. I'm having a breast augmentation w/ silicone to fix my tuberous breasts which i am so happy about. My PS says i don't need an aerolar reduction but i'm not sure. As you can see my breasts look very different depending on the temperature. Would a transaxillary incision be possible to minimize scarring? What cc would look best if i want to be a full b? Which profile would suit me best? Is there a technique that would work best? Thank you so much for your time.
What is the Best Way to Correct my Tuberous Breasts? (photo)
Doctor Answers (12)
Find the very best surgeon you can, and then trust them to do their best
Normally, my preference in a case like yours would be to add the peri-areolar (around the nipple) breast lift. However, it is very important that you take what I say (and anyone else who hasn't met you) with a very large grain of salt...
I know that what you are looking for is reassurance that the plan you are undertaking is the best one for you, but the fact is that considering none of us here has spent the time talking to you about your goals as the surgeon you have chosen has, and as none of us here has examined you in person, none of us is as qualified to advise you on your options and plan as your surgeon is...
It would be a mistake to follow a recommendation given by someone (no matter who) over the internet over a qualified surgeon who has examined you and with whom you have a relationship.
The very best advice I can give you is to choose the very best surgeon you can find based on his education, training, experience, skill and talent (look at lots of photos- and not just of the procedure you want), communicate carefully about your goals, listen carefully to your options and the limitations of each, and then trust the surgeon you so carefully chose to do their best to make you happy.
Second guessing your plan on the web is only going to cause you unnecessary and avoidable anxiety (especially if your surgeon's recommendations end up producing the lovely outcome you desired), or worse, will lead to the unfair destruction of your doctor-patient relationship with your surgeon if your outcome is less than perfect (because you will unfairly believe that if he had done what one of us told you would be best you would be happier).
Please, please, please, spend no more time asking us about your options- rather go back to your surgeon and ask HIM... If you are uncomfortable with the plan he outlines for you, then by all means seek second opinions- but be sure you understand the pros and cons, and that the opinions you get are from people you can believe have the skill and talent to approximate your goal after they have carefully examined you.
Breast augmentation and tuberous breasts
Based on your photos, you have some asymmetry and tuberous nipple-areola characteristics but are otherwise suitable for a breast augmentation alone. This is the simplest and most predictable. I would then re-evaluate after at least 3 months to see if a secondary procedure to adjust the nipple-areola size, puffiness, and position is worth the incision scars.
I would strongly advise against an axillary approach as this gives poor control over the inframammary crease level which needs to be lowered significantly. The dual plane release of the pectoralis muscle out of the lower pole of the breast is also best done from the inframammary crease approach. Long term adjustments or replacements are also best done through the inframammary crease incision.
Implants are sized by measuring the true width of your breast and fitting the diameter of the implant to it while adjusting the lower pole of the breast to allow for a properly centered, round implant. The forward volume (profile) of the implant ranges from 1 - 2 cup sizes in saline or silicone gel. Silicone gel is probably a good choice as the coverage of the implant in the lower half of the breast in this situation will be mostly skin.
An around-the-nipple breast lift with implant size of your choice is likely your best option.
Thank you for your question and the photos.
An around-the-nipple breast lift with implant size of your choice is likely your best option.
To be sure, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery. I hope this helps.
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Most patients that come in with tuberous breast tend to want an increase in breast size and decrease in areola size. We often recommend bilateral silicone breast augmentation with high profile implants with periareolar lift. We recommend breast implants to change the shape of the breasts from tuberous to round, as well as to even and enhance the breast size. The periareolar lift, helps to position the areola evenly and decrease the areola size, giving a more aesthetically pleasing looking breasts.
Tuberous Breast Correction
Correction of your tuberous breasts is best done through a periareolar incision to reduce the size of the areola and release the breast tissue in the areolar area. A transaxillary incision would not be recommended.
Correcting Tuberous Breasts
Thank you for posting several photos.
Depending on a physical examination that the surgeon could offer, one or several options may be available to you.
However, it seems that circumareolar incisions will allow the surgeon to augment your breast and reduce the diameter of your areolas controlling the change you have described to a certain level.
A transaxillary and inframammary entries are great options but if you desire to control the size of your areolas, then a circumareolar incision will have to be made.
I encourage you to have a consultation with a well reputable surgeon of extensive experience who will be able to help you to make a well informed decision.
Thank you for your inquiry and the best of luck to you.
You have several options but an incision at your areola border will likely be the best.
Tuberous breast deformity is characterized by an excessively high and tight infra-mammary fold (IMF). The key to correcting this contour is augmentation as well as opening up the IMF. This allows the implant to sit in its ideal location which in turn allows the lower pole of the breast to round out as is natural. These two things can be accomplished via a transaxillary incision, an incision at the border of the areola, or an incision at the IMF. Of these three incision the incision at the border of the areola will be best since it will allow your plastic surgeon the greatest control as well as provide the opportunity to reduce the areola diameter if needed at the completion of the case.
All the best,
Dr Remus Repta
Dual plane augmentation with a circumareolar mastopexy would be best for your tuberous breasts
Hi Lisa, based on your photos, I would not recommend a transaxillary approach/incision and am surprised that this is how your were advised. The best approach in your case would be a dual plane augmentation through the nipple (periareolar incision) which releases the tight lower pole of your breasts. I would also perform a circumareolar mastopexy to diminish both the size of the areola and herniation into the areola.
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.
In order to achieve a full b-cup size breast, a small round smooth silicone implant would also be needed (probably near the 300cc range given your dimensions). 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.
Transaxillary Incision For Tuberous Breast Correction
Thanks for your question and the photos. While a transaxillary incision would hide better than an incision around the nipple, this is not a good choice for patients with tuberous breasts. Tuberous breasts have many challenges for the surgeon to address including malposition of the under the breast fold, tightness of the lower breast tissue than requires precise release, herniation of the breast through the nipple-areola area, and size problems. These are difficult enough to fix through the nipple but are going to be extremely difficult to address with the under the arm approach.
I would recommend an around the nipple approach to correct the herniated breast tissues causing the puffiness to the nipples. I would release the lower breast tissues by scoring the breast. I would also gently correct the IM fold position but with the understanding that we may have to come back in a second stage to obtain the ideal position. As far as the implant size, I would recommend being on the conservative side rather than trying to overstretch your tissues in one setting. I would also like to use cohesive gel or silicone gel implants which also impart some shaping to the breast. Discuss your concerns with your plastic surgeon and best of luck.
Tuberous breast correction
I would not suggest a transaxillary incision for you. You have wide intermammary distance and precise pocket creation is going to be important. In addition, there may be a need for radial scoring of the breast tissue to correct some of the tubular constrictions of the breast. This is difficult enough using a periareolar incision, let alone a transaxillary incision. The size and profile of the implants is something that you will need to discuss with your surgeon. I would suggest a periareolar incision with subpectoral placement of silicone gel implants. You will likely need some radial scoring of the tissue just behind the areolae and some careful softening of the tissue just above the inframammary fold. I would want to have permission to complete a circumareolar mastoepexy (areolar reduction) after the implants have been placed.