I was diagnosed with tuberous breasts and had implants to 'correct' this, from a size 34aa to a 34c, under the muscle. They were done four years ago, and one implant hasnt 'settled' and is much higher up than the other, the other has settled rounding out the tuberous shape. They look awful. I have been told by another surgeon that it is likely the muscle is holding the right implant up in a high position. Am I entitled to have this corrected free from the original surgeon?
Tuberous Breast Surgery Gone Wrong?
Doctor Answers (11)
Tuberous Breast Surgery Gone Wrong?
Thanks for being so kind to post a photo. After 4 years do you really feel you should not be charged for the revision? I know of no surgeon after this length of time that would do a gratis surgery. from your photo the left result is very good, your right needs a lowering of the inferior crease and a slightly larger implant. From MIAMI
Tuberous breasts and revisions
I agree on most of the comments. Tuberous breast is not a single type of condition or breast contour and can even vary from one side to the other. There appears to be some residual tuberous or constricted condition under the nipple-areola on the left which is otherwise a nice result. Correcting this would require a circumareolar approach rather than an inside or implant-type revision.
The right breast looks higher than it is because of the shoulder position but it does look like the lower pole was not filled out adequately and this is usually from inadequate release of the lower edge of the pectoralis muscle or the fascia in the lower pole. This would require an open revision with or without replacing the implant. I do not think it represents capsule contracture and should be correctable at least to the degree of the left side.
An important issue and warning for other patients considering elective, cosmetic surgical procedures: All plastic surgeons handle this issue differently and the key is to have the definition spelled out before the surgery and the costs for such procedure stated. My professional approach is to define a procedure as a revision if it is within the first year after the surgery and the patient followed up properly and the problem is something that did not heal the way it was intended but is correctable. There would be no surgical fee for such a revision but the patient is responsible for the facility fees and implant costs if they are not covered by the manufacturer under the warranty. Others will have a different approach but the point is to have this clearly stated and handled consistently.
Augmenting a tuberous breast
Looking at you picture, it appears there is likely a capsule contracture that has lead to a majority of the asymmetry. Some adjustment of that side is warranted. Costs are variable depending on the contract you have with your surgeon. In our practice we would charge for issues such as this, as it is a healing problem and out of control of the actual surgical procedure.
Wishing you all the best,
Tal Raine MD FACS
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Tuberous breast surgery gone wrong
I am sorry that you are unhappy with your result. It is difficult to comment on your result without seeing the preoperative photographs. Personally, I do not think that they look awful, but there are some asymmetries, which could be improved with surgery.
You are always best off going back to your original surgeon, but you are not entitled to have corrective surgery for free, unless that was agreed beforehand. Most hospitals offer free revisional surgery for the first 12 months after surgery. Good luck.
Tuberous breasts are very tough to deal with and your results do not look bad except that one breast is a bit high. AS for the price you should talk to you doctor, I am sure he would give you a break.
Tuberous breast surgery
Tuberous breasts is a descriptive term and can refer to a wide variety of breast shapes. However, one of the hallmarks is a contricted lower pole which usually means the inframammary fold is disproportionately high relative to the breast gland. This is significant because placing an implant to lower the fold and expand the lower pole can result in this "double bubble" contour. True tuberous breast shapes are almost never perfect after "correction" because of the deromity of anatomy as well as the usual asymmetry present.
I think your results are certainly "acceptable" even though there may be things a surgeon can do to move the shape more to your liking, it is probably that you will have to accept other compromises such as additional scars or smaller breasts.
Robin T.W. Yuan, M.D
Tuberous Breasts pose a difficult surgery-
Tuberous breast create a challenge, in general, because it is sometimes difficult to get the breast tissue to relax to the extent that one would like to achieve a symmetric and rounded breast. It looks like the overall shape of your breast is rounding out nicely. There is some visible asymmetry in height, as you express, which perists. The height of the breast with a tuberous deformity is frequently very different from side to side. Because the tuberous breast deformity is, in itself, a challenge to get round I think that having to go back for revision is not necessarily the fault of the surgeon, but a reflection of the difficulty of the abnormally formed breast. The overly tight lower pole of the breast and elevated inframammary fold are the known, primary issues of tuberous breast deformity which partially produces the abnormal shape of the breast.
Unfortunately, revision surgery usually requires hospital and anesthesia fees which are usually covered by the patient. You may find that your surgeon is willing to cut their price significantly to try and further correct the ongoing deformity. However, implants placed to help correct a tuberous breast is more of a reconstruction that may need more than one surgery to fully correct. Reconstructive surgery should be covered by insurance, but unfortunately, is not usually covered by most insurance companies. Tuberous breast reconstructions may require a few revisions to get the result perfect. I would discuss the options with your surgeon, as it appears as though you have achieve a very nice rounded breast in both which is the 1st step of the reconstruction. Your surgeon may be able to revise the pocket further to try and achieve better symmetry in position of the implant.
Surgery for Tuberous Breast Deformity
First of all, if you truly had tuberous breasts, I think you have a good result. In your photo, your right shoulder is significantly higher than your left shoulder and this skews things a bit. If you are unhappy with your result, though, this is a matter which you should discuss with your original plastic surgeon.
If I were your original surgeon, I would want to see you back, especially if you are not satisfied. Give him the oppurtunity to review the result and come up with a resolution. Though a free surgery is unlikely, he may discount his services as a courtesy. Best of Luck to you.
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