What would be the best approach to fix my tubular breasts? (photo)

For severe tuberous breasts, I usually use smooth, round implants placed through an inframammary fold incision combined with a periareolar mastopexy to reduce and support the areola while at the same time achieving a small lift to balance nipple position. The position of the implant (subglandular vs submuscular) depends on the thickness of the patient's breast and chest tissue. It is highly likely that there is a connective tissue band within the lower quadrants of your breast tissue that restricted the development of your breasts resulting in the deformity. The IMF incision will give your surgeon access to that band of connective tissue, which must be cut in multiple locations (called radial scoring) to allow the breasts to take the shape of the implant and fill out the inferior breast quadrants. If radial scoring is not adequately performed, you will have a double-bubble deformity after your augmentation. The IMF incision should be designed based on the ideal position of the breast crease with the implant in place, not necessarily where the breast crease is currently positioned. Breast augmentation for tuberous breasts is very challenging. Sometimes it is necessary to plan two surgeries to safely achieve the patient's goals. You may need a third consultation to find the right surgeon for this difficult procedure if the second surgeon appears to be underestimating the complexity of this operation.

Your photographs are inadequate but from what I can see your breasts appear ptotic. I would need a true frontal view and true side views without nipple coverage. The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. The areolas can be reduced to the size you desire. At the same time, fat transfers or small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Good morning,
You are an excellent candidate for a donut mastopexy to reduce your areolas and tighten your skin and a submuscular augmentation. You may choose saline or silicone gel, depending on your preference. We would determine the exact size and profile when I measure your chest, we review photos together, and you have an opportunity to try on the implant sizers here in the office.

For your type of deformity, combination of peri-areolar breast lift (to reduce size of areola and reshape lower, narrow pole of the breast) and augmentation with sub-muscular implant would be good approach. Good luck.

Unfortunately, without better pictures and more information, it is impossible to say what will work best for you. With Tuberous breasts it is not uncommon to need an areola reduction and/ or actual lift along with implants. The best thing to do is to go for a few consultations with board certified for plastic surgeons and see what the consensus is. I hope this helps.

The first surgeon is correct. Your breasts are more sagging than constricted, so it will do well with a simultaneous lift and implant. Your breasts will not obtain a pleasing shape without a lift.

I recommend an in person evaluation with a plastic surgeon to be measured and discuss your goals. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Thanks for your question and photo. An examination in person would be required to properly determine how to best help you, and the one photo you provided is unfortunately not sufficient to render an opinion. That said, an implant alone is highly unlikely to answer your concerns, and you almost certainly need a lift, with or without an implant. It seems as though your recommendation for an augmentation mastopexy is most likely correct and accurate.
I advise you to select your plastic surgeon based on multiple factors including his or her Before and After gallery, reviews, and most importantly, your gut feeling as to whether you trust him or her. Best of luck to you.

Dear Fabulous933340,
tuberous breasts are not simply small or underdeveloped breasts. The appearance of the breast can range from mild to severe, and typical traits include: enlarged, puffy areola, rather wide spacing between the breasts, very little breast tissue, sagging, higher than normal inferior breast fold, and narrow base at the chest wall.The type of surgery best for you will depend on the severity of your condition.My preferred technique for tuberous breast correction involves a multistep procedure where the breast tissue is released in a radial pattern to prevent herniation into the areola and placement of a custom implant size is in the breast to allow appropriate expansion of the breast in the restricted dimensions. This can often be done in a single procedure but sometimes may require two surgeries.That said, it is best that you visit a board-certified plastic surgeon for an in person examination. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Your one photo is limited since you covered most of your areolae, but I think an augmentation and lift should do well. Measurements are needed to be certain.