I am a 20-year-old woman with a mild case of the "tubular" breast deformity. I have the large, puffy areola, but my breasts are not as narrow as many shown in the pictures. They moreso just point downwards with no upward curvature. I also think I have a fair amount of breast tissue and wear a B/C cup. I am considering getting saline breast implants and have some concerns: Will subglandular or submuscular placement look more natural? Which shape (I've read there is anatomical and teardrop) of the saline implant will achieve the more natural upward curvature?
Saline Breast Implant Placement and Shape for Tubular Breasts?
Doctor Answers 8
Tuberous Breasts Correction
I prefer the use of smooth, round, partially submuscular ("dual plane") breast implants for correction of tuberous (constricted) breasts.
Tuberous breasts generally have a very narrow base, short distance from areola to inframammary fold, tight (constricted) lower pole of the breasts, relatively wide space between the breasts, "puffy" and areola and some degree of ptosis (drooping).
Generally, the procedure involves breast augmentation with areola reduction / mastopexy procedure. The distance from the inframammary fold is increased (to create a more rounded out appearance). Proper implant positioning improves the distance (cleavage) between the breasts. The areola reduction helps to treat the pointed and "puffy" appearance of the areola.
In the most severe cases of tuberous breast, a more complete breast lift may also be necessary. 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 and that revisionary surgery is more likely than in patients who do not present with tuberous (constricted) breasts.
I prefer sub muscular or what is called dual plane to provide more soft tissue coverage over the superior pole. I also prefer round smooth over textured or anatomic.
Saline Breast Implant Placement and Shape for Tubular [tuberous aka constricted] Breasts?
I have found that submuscular placement of moderate plus conservatively sized saline implants with dual plane glandular dissection and radial relaxing incisions and circumareolar mastopexy works well for tuberous breasts
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Breast implant placement and shape for tubular breasts?
As the posts beneath mine attest, three good Plastic surgery with slightly varying opinions.
In your case, I agree more with the opinions voiced by Drs. Horn and Rand.
Tubular Breast Deformity is a MISNOMER. It is NOT one deformity but a spectrum of different deformities, imperfections and variants which TOGETHER are best classified as a "tubular breast".
In YOUR case - you have " the large, puffy areola, ...breasts are not as narrow as many shown in the pictures. They ...just point downwards with no upward curvature. I also think I have a fair amount of breast tissue". This would mean that your areolae would need to be lifted, made less puffy by removal of some of the protruding breast tissue directly underneath them. A Mastopexy (breast lift) would accomplish that. A breast augmentation would give you more upper pole fullness (correct the "no upward curvature") but it probably would have to be done after making sure the breast base is not constricted and correcting it - if it is. ANY breast implant may be used, there is rarely a role here for textured anatomical implants which leak, crease and VISIBLY rotate sideways more frequently. Round saline implants are cheaper than round gel implants but they are both good. An under the muscle position is preferable, in my opinion, to an under the breast which is more prone to show the implant and any ripples as time goes by.
Peter A Aldea, MD, FACS
Correction of tubular breasts.
Breast implants alone (any kind of implant) will not make you look better. You also need to have your breast tissue internally re-shaped and lifted through a circular scar around the nipples.
Once the shape is right, I would recommend small silicone implants placed over the muscle.
Breast implants for tubular breasts
Tubular breasts can look much nicer after a breast augmentation. Depending on the how tubular your breasts are to start, you may benefit from an around the nipple lift to flatten the areola (pigmented area around the nipple) and make it smaller. When the bottom of the breast is tight, work on the inside of the breast to release the tissues can round out the lower part of the breasts.
Round implants look more natural than anatomic ones because when you stand up, the round implants appear somewhat teardrop shaped. When you lie on your back round implants appear round like a natural breast, teardrop implants stay teardrop which looks silly.
In general, implants beneath the muscle look more natural and have less risk for hardening with time.
Tubular breasts come in a range of severities. It sounds like yours is mild and mostly manifested in the areola. A periareolar mastopexy can lift your areolas and decrease their diameter some also. The implant should be submuscular for the best long-term look, better mammography, and less risk of capsular contracture.
Round implants are typically used becasue shaped implants have to "stick" to the tissues in order not to rotate around in the pocket and look asymmetrical to the other side. Sometimes they don't stick so they can cause problems the round ones don't. As long as the right size is chosen, round implants don't look like big balloons.
Sub-glandular placement may be required for to breast breast
Thank you for your question. I agree with other doctors that placing implants under the muscle is the best option when doing breast augmentation. However if you have a significant constriction of your breast a radial mastotomy to release the constriction should be performed through a pocket dissected beneath your breast on top of the muscle. While sub-muscular placement may fill the constricted breast following this maneuver and should be tried, if the muscle does not adequately expand and the breast redrape appropriately over the muscle, then Sub-glandular placement may be necessary. In some patients soft tissue expansion to expand and normalize the shape of the tuberous breast can be done first followed by sub-muscular implantation at a second procedure.
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.