Are my breasts tuberous and what would be the optimal placement of an implant?

Question

Hello docs! Thank you kindly for taking your time to review. Attached are my measurements from my first consultation. Do my breasts looks tuberous? If so what type and what class and what type of lift do I need? Would I be fine with just doing a crescent lift? Would it be more beneficial to place implants in dual plane or subfascial location and why? Could I get away with high profile silicone implants or should I keep them mod to mod+ for optimal shape?

Steven Sigalove, MD FACS · Answer

Implant selection is truly something that is based not only on your objective measurements obtained from bio dimensional analysis, but also your subjective goals regarding the aesthetics of your breasts. It is impossible to tell you what implant you should get strictly based on your measurements alone. The projection of the implant dictates a lot about your ultimate aesthetic outcome, for instance are you looking for an extremely natural look or do you want to look like a stripper. You have a mildly tuberous breast defect, and, in my practice, I treat these exclusively with subfascial augmentation plus lower pole support with Galaflex. Additionally, a circumareolar mastopexy is almost always used in order to create a proportionate looking and appropriately position nipple areolar complex. In some instances, sometimes even an inverted T mastopexy is utilized.

Gary M. Horndeski, MD · Answer

Your breasts are not tuberous but asymmetrical and ptotic. The lift technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ted Eisenberg, DO, FACOS, FAACS · Answer

Unfortunately, surgeons have created the term tuberous breasts, a fact which causes unnecessary concerns for women. Many women just have different sizes and shapes and in my opinion shouldn't be labeled. 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

Carmina Cardenas, MD · Answer

Definitely you have tuberous breast and the features are: tubular shape, constricted  base, large areolas, wide gap in between breast, plus you have a very obvious asymmetric size, shape, position of areola-nipple complex, and inframammary fold position. You have a first and second degree saggy breast and you will be candidate for areola reduction, asymmetric breast lift, reduction on the left side, otherwise impossible to fix the tuberous breast. Regarding the augmentation most likely sub muscular small implants moderate plus or high profile but not ultrahigh or either those full 100%. 
My recommended size: No larger than Full C. Prob around 275-300 Cc. 
Be encouraged. 
Dr. Cárdenas

Robert Oliver Jr., MD · Answer

I would not call that a tuberous breast deformity. It really doesn't have strong features of the classic term.

I would suggest you would need a lift, and I would not use high profile. In fact, id suggest using low or low-plus profile devices (which do very well with lifts)  as you already have a lot of breast tissue and it's easy to overshoot the mark from tasteful to tacky volume wise.

You could go sub fascial as you have thick tissue, but they will sit a bit lower then a dial plane if you don't use mesh sling sometimes

Are my breasts tuberous and what would be the optimal placement of an implant?

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