I have tubular breasts; I'm about to book in for a consultation but he wants to go over muscle? (Photos)
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Doctor Answers 4
Hi. Whether you can have an implant above or below the muscle is not really that big a deal. You should imagine that in your specific situation that it is about the appearance of the upper pole - under will give a more natural look. The critical thing is that the inferior pole is released both from the underlying muscle and the constricting bands. This means you need a dual plane 2 or 3 if you go under the muscle or else you will definitely get a double bubble appearance. Once again the implant choice is not critical but an anatomical will give you more tissue expansion in the lower pole where it is required.
Hello and thank you for your question. The
best advice you can receive is from an in-person consultation. You are a
great candidate for a breast augmentation with release of lower pole constriction bands. The size, profile, and
shape of the implant is based on your desired breast size/shape, your
chest wall measurements, and soft tissue quality. This decision should
be based on a detailed discussion with equal input from both you
and your surgeon. This entire surgery
can be performed with a small incision technique. Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results. The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon
Tuberous breast surgery concerns...
Thank you for the question.
Tuberous ( constricted) breasts are characterized by a wide spectrum of presentation including constriction of the breast base, glandular and skin hypoplasia (especially at the lower quadrants), mal-position of the infra-mammary fold, breast tissue herniation into the areola region and sometimes increased areola diameter.
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. 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.
Although every surgeon may have their own preference, I would prefer to place the breast implants in the sub muscular (dual plane) position if at all possible to minimize risks associate with breast implants placed in the sub glandular position.
Probably more important than breast implant positioning, is selection of a surgeon who has significant experience treating constricted/tuberous breasts.
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. ***Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example,
I have found that the use of words such as “natural” or "C or D cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this, and the attached link, helps. Best wishes.
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Measurements and a careful examination are necessary.
During your visit with your plastic surgeon, he or she will need to assess all of the tissue factors that will help determine whether on top or under the muscle would be best. In my practice, I generally go under the muscle in nearly every situation because of these three reasons:
#1 The implant will look smoother because there is more meat on top of it. This concern is especially important if your measurements reveal that you are very thin. If so, then placing the implant on top of the muscle can expose those normal folds in the implant, potentially making them visible.
#2 The radiologist will have less difficulty interpreting future mammograms with the implant separated from the breast tissue by the muscle.
#3 Your risk of developing a tight scar called a contracture will be less if you go under.
Lastly, tubular and constricted breast deformities are one the true indications for a shaped implant (NOT round). The tendency of the shaped device to push the lower part of the breast outward more than the top is a huge advantage in patients such are yourself.
Hopefully these answers will help you in your decision making as you discuss these issues with your plastic surgeon.
Best of 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.