Tubular Breasts Revision - How Do I Correct This?

I had a tubular breasts augmentation 1 year and a half ago.Since the beggining, I noticed something was wrong and my surgeon asked me to wait until 6 months post op, but one month after my surgery I had to leave the country so he couldn't do the follow up.I didn't write him either because I was a little depressed about my breasts.Now I am determined to have a revision and I am looking for a new surgeon but first I'd like to understand what happened. Thank you for your precious help

Doctor Answers (12)

Tuberous / tubular breast revision: there is a solution

+1

There are several things that create the undesirable aesthetics.  Firstly the implant base width appears to be too narrow for your chest wall dimensions.  Secondly the inframamary fold needs to be lowered.  Thirdly, you have undesirable lateral inferior stretchning that is very common with dual plane placement.  Placing breast implants under the muscle creates a few aesthetic problems.  This is the reult of releasing the inferior portion of the pectoralis major muscle.  The more superior origins will not allow the implant to sit in a natural place and the continual forces of the muscle constantly push the implant down and out.  When this is combined with excessive undermining of the inframammary fold, the deformity that you are seeing results and continues to progress.  This is a very common finding with submuscular placement.  To understand these forces better, stand in front of a mirror topless, put your hands on your hips and push down onto your hip bones firmly.  You will see both breasts move down and out.  these forces over time always cause lowering, lateral displacement, thinning of the breast tissue and stretching of the skin.  This is the reason that I use a unique technique in my practice called 'cold-subfascial augmentation.' THis technique leaves the muscle alone and out of the equation but should not be confused with 'above the muscle' which I would also not recommend.  The cold-subfascial augmentation harnesses the strong structural power of the pectoral fascia to create a truly natural breast shape and act as a living structurally sound brassiere inside the breast protecting the breast from the pressure of the implant and forces of gravity.

I have seen many patients with identical problems to the one you present and in my opinion there is only one good solution- changing placement to a new cold-subfascial plane. I also use a unique technique to add symmetry to the nipples and reduce the areolas with a hidden scar and no circular scar around the areola. I hope this helps!

 


All the best,

Rian Maercks M.D.


Miami Plastic Surgeon
5.0 out of 5 stars 32 reviews

Breast asymmetry can be corrected.

+1

Hi.

It is true that we don't know what was done, but it does not  matter.

1) You need correction of the tubular shape of your right breast, with release and expansion of the lower half of the breast. This is difficult and often mishandled. The correction can be done through the areola. Actually, you have a mild tubular deformity, perhaps because already partially corrected by your first surgery.

2) The right breast implant is too high.

3) You need a good lift of your left breast, which is probably best done with a lollipop scar (Lejour technique).

4) Finally the volume of each breast breast needs to be made the same. Based on your pictures, I would suggest a small reduction of the left breast and different implants.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast revision surgery

+1

First of all, you look quite asymmetric although your arm positions are different and this may be creating an illusion. Second, your nipples are too low, called ptosis. Your surgeon should have not just placed implants without talking to you about a lift. The lift would have not only brought your nipples to the correct position, but also decreased them in size.

Arian Mowlavi, MD
Laguna Beach Plastic Surgeon
5.0 out of 5 stars 9 reviews

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Need picture of situation before operation

+1

Dear lady, although it is hard to judge the symmetry with your arms in different positions,  it indeed seems like the lower part of your right breast is still too tight. 

Making a plan for correcting this is very hard without pictures of the situation before the correction. Most likely the implant on the right needs to come down a bit more, the gland needs to be expanded/scored, and you need an extra lifting on the left breast, possibly also a slight reduction on that side.

Alexis Verpaele, MD
Belgium Plastic Surgeon

Tubular breasts

+1

Thank you for the post-operative picture but without the pre-operative picture it is hard to know what was done or is happening.  In general tubular breast cases can be very difficult to correct.  You usually need to perform both an augmentation with a peri-areolar mastopexy with radial scoring of the breast gland.  It appears from your picture that your left breat may require another mastopexy  and possibly a smaller implant to achieve symmetry.  Good luck. 

Vishnu Rumalla, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 75 reviews

Tubular Breasts Revision - How Do I Correct This?

+1

You provide a photo, but no photo of what you looked like before surgery.  It appears that your right breast is naturally smaller than the left.  You have a variety of options to improve your breasts, but it is a bit lengthy to go into everything- I recommend that you consult with a few Board Certified Plastic Surgeons.  If I were performing your surgery, I would discuss with you mastopexy to lift the breasts as well as revise the implant pockets so that there is not a definitive difference between where your natural fold is, and where your implant sits. If you refuse the scars of a lift, I would perform a capsulorraphy and likely change the implant profile and possibly the implant pocket.  Good luck!

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 86 reviews

Tubular breast correction

+1

The way i see it you have 2 problems.

1.The tubular breasts  with obviou lack of fullness of the inferior pole of the right breast.

2. left breast ptosis with the nipple pointing down .

 

your correction will require expanding the inferior pole of the right breast and allowing implant migration downward  thus the nipple will be pushed up.The left breast will require  nipple areolar position adjustment to bring it into alignement with the new position of the right..

Erel Laufer, MD
Tampa Plastic Surgeon
4.5 out of 5 stars 14 reviews

Revision in a tuberous breast

+1

The thing that distinguishes a tuberous breast is constriction of the skin envelop and herniation of the nipple areola. There are many degrees of constriction, however your breasts are asymmetric though not tuberous. The smaller breast  is limited by the tightness of the breast fold which is unlikely to relax further, but the capsule could be opened to encourage the implant to sit lower and a lift would look nice. The larger breast needs a smaller implant and a lift to bring the nipple up front and center.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 29 reviews

Breast Asymmetry and Tubular Breasts

+1

These cases are challenging and often patients (and surgeons) have unrealistic expectations.  Sometimes the surgery involves implants with stretching of the lower part of the breast on the smaller side.  It often requires two surgical stages to accomplish this.  Also, it often is necessary to reduce or change the position of your larger breast to help match.  I would really recommend meeting with more than one Board Certified (by the ABPS) Plastic Surgeon who has some experience with these cases.

Jeff Scott, MD
Everett Plastic Surgeon
5.0 out of 5 stars 9 reviews

Tubular breast surgery revision

+1

It looks like you need a little more of a release at the inferior aspect of the breasts below your nipples, and perhaps slightly smaller implants that fit your frame a bit better.  Tubular breast surgery is extremely challenging, and it's not unusual for patients to require more than one procedure to fully correct the problems.  In addition, many tubular breast patients tend to be asymmetrical, which adds to the complexity of the procedure.  If you choose to undergo a revision, be sure to ask your surgeon about his or her experience with tubular breast surgery.  Best wishes, /nsn.

Nina S. Naidu, MD, FACS
New York Plastic Surgeon
4.0 out of 5 stars 5 reviews

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.