Tuberous breast & Augmentation. Should I get the implant behind the muscle? (Photo)

I just to find out I had "tuberous breast". The recommendation for me was fat transfer and I'd not be able to get bigger that a small B. For a second opinion I got that I could use a anatomic implant (275 cc recommended). He'd perfom an under mammary fold incision. (not sure how, because I don't have any folds). Is an areola reduction necessary? Does the procedure need to involve release of constricted tissue? (They didn't mention this). Should I get the implant behind the muscle?

Doctor Answers 10

Tuberous breast options

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Hello, there are many options to treat tuberous breasts; often this involves reducing the size of the areola, inserting implants, and releasing constricted breast tissue to help it expand.  There are other options depending on your anatomy and your desired result.  If you are uncertain about your options I would suggest contacting your PS and/or considering a second opinion.

Implant placement

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Thank you  for your question and photos. The type and placement for your implants is best recommended by the Plastic Surgeon you have chosen to do your surgery. There are benefits and reasons for choosing different approaches depending on your anatomy.

All the best

Tuberous breasts

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I prefer to use a shaped anatomic implant in patients similar to you.  Planning where the new fold will be is fairly simple for the experienced plastic surgeon. However I prefer an incision around the areola in a patient like you, in order to reduce the size of the areola and flatten the triangular nature of your native breast.  Radial scoring the breast tissue is helpful (also called release of constricted breasts) and sometimes a removal of some of the breast tissue on one side or both is helpful.  In tuberous breast cases I release the breast from the muscle (dual plane type 3) and place the implant partially under the muscle.  This allows for nice soft tissue coverage on top portion of the breast with a nice natural slope and for maximal expansion of the lower pole of your breasts. I hope this helps and best wishes. 

Tuberous breasts

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There are many ways to treat this. Often it requires an implants, potential scoring of the lower pole to expand it, and reduction go the tissue herniating through the areola by a circumareola reduction. I usually put the implant under the muscle.

Tuberous breast treatment

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Treatment of tuberous breasts varies depending on the degree of the breast architectural distortion. Surgical correction typically involves:

-areolar reduction
-submuscular augmentation
-release of constricted breast tissue

All of these techniques work in concert to correct the tuberous deformation of the breast. 

As always, discuss your concerns with a board certified plastic surgeon.

Tuberous breasts and breast implants

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I would obtain another opinion, You do indeed have a variant along the tuberous breast spectrum (remember that each woman is different). Fat transfer has been performed by a few surgeons, and has usually been shown to be effective with the use of an external tissue expander (the BRAVA device). Although promising, I would argue that most plastic surgeons do not have extensive experience with this technique, and it does involve a lengthy course of treatment and in your case probably several procedures. Most surgeons (myself included) would recommend the use of breast implants. I do not believe it will be possible to obtain a release of all the constricting bands which developmentally extend from your areola and radiate outwards (in both your deep tissues and right underneath your skin) through an inframammary incision. You need to have a peri-areolar incision to accomplish this and to release the constricting bands which are causing your areolar tissue to herniate. Your situation is unique, and I would recommend you visit several surgeons to find someone whose recommendations you are comfortable with. Good luck!

Tuberous breast & Augmentation. Should I get the implant behind the muscle?

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Thank you for the question and pictures. Yes, your photographs to demonstrate some of the characteristics seen with tuberous/constricted breast. Generally speaking, some of the characteristics seen with tuberous breasts include 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" areola and some degree of ptosis (drooping).

Generally, correction of tuberous breast anomalies 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.  I usually place breast implants in the sub muscular (dual plane) position.The areola reduction helps to treat the pointed and "puffy" appearance of the areola.  Over time, the appropriately selected and positioned breast implants serve to round out the lower poles of the breast and improve the appearance of the cleavage area as well.

In your case, I would recommend the circumareolar approach and utilization of silicone gel breast implants placed in the sub muscular position.

Patients undergoing breast surgery should make sure that their selected plastic surgeon has demonstrable and significant experience achieving the types of outcomes they would be pleased with. You may find the attached link, dedicated to breast surgery for patients who present with constricted/tuberous breasts helpful to you as you learn more. Best wishes.

Tuberous Breast and Augmentation

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With tuberous breast you are sometimes limited on what size implant you can place. You do need to address the "constricted" tissue and sometimes reducing areole size helps.  I would rather use a prareolar incision than a inframammary incision which would be more obvious. Fat transfer may be an option but I don't things it is the best approach.

Harry Marshak, MD
Beverly Hills Plastic Surgeon

Tuberous Breast

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Thank you for question and providing photos. Based on the photos I do believe you have tuberous breasts. I have successfully augmented many women with tuberous breasts. Given the amount of breast tissue you have I would recommend submuscular placement. I would also recommend a full peri areolar incision to help set the nipple areolar complex back. This will help the tuberous component. I believe you could use a round or non round implant. I do believe you would be better off with a silicone gel implant. I hope this helps and best of luck

Tuberous breasts

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 From the photos you have provided I would tell you that even with 25 years of experience that this is a very challenging case. There's lots of ways to do it I can only tell you what I would do. I would do a purse string mastopexy to make the areola the same size and set back the puffiness that's just below the areola and nipple. I would place a small implant around 200 mL or so through the bottom part of the mastopexy incision. In my experience, one of the absolute things that has to happen in the procedure is a stretching both in a horizontal and vertical direction of the skin from the bottom of the areola to wherever the new crease ends up. Like I said, this a hard one and there's lots of ways to do it. I would ask your potential surgeon for photos of some similar challenging cases that they have done in the past. Good luck.

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.