I have small B's and suffer from constricted breasts. I have good distance in the upper pole of my chest but there is a short distance from my crease to the nipple, snd my right breast is smaller and the distance is even shorter. One PS wants to usr the same implant size on both sides but use fat transfer to balance out. He will go through the armpit.second PS wants to go 25 cc larger on right side no fat and lower crease. He will go incision via crease.right breast is a about 40 cc.
Constricted Breast- Concerned with Post Op Symmetry and Double Bubble Effect!
Doctor Answers 7
In neither of the opinions you discuss do you mention anything about the correction of your constriction which, itself, can not be done through either an incision under the breast or the armpit. A photo would help to advise you further.
Tuberous Breast Correction
Correction of tuberous / constricted breasts is not straight forward so you really need to go see a surgeon who has experience with this specific surgery. I do not agree with using the same size implant and supplementing with fat transfer when a patient has asymmetry. Since I have not examined you, I cannot say exactly what I would do but my preference is to use an incision around the areola to have the best access to the constricted breast tissue that needs to be released as well as using different sized implants to assist with the asymmetry (if needed). Please make sure your surgeon has experience, as with any breast surgery there are risks and complications.
Without photos it is hard to address your concerns specifically. It sounds as if both your breasts have a Type II tuberous deformity which means only the lower half of your breasts are tight; not your whole breast or just the lower inner quadrants. If the volume difference is small (and 25 cc is small) then using the same implant volumes will mean your breasts will have the same amount of asymmetry that they do now. Using a larger implant on the smaller side means you will have a tighter skin envelope and possibly more fullness in the upper pole on your right side. This is something to consider in your case where the skin is tight to start with. Almost all women have a small degree of asymmetry and in 70% of them the left side is the larger side. At least in this regard you have a lot of good company. I have found that a peri-areolar approach is more reliable with a tubular breast. I can lower the fold little by little instead of committing to it before I start. A tubular breast is not one I would use a transaxillary approach for. There is not enough control and trying to revise it through the same incision later is even more difficult. Many women end up with either peri-areolar or inframammary incisions, too.
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Treating constricted breasts can be difficult. Often they require revision. The lower pole is often tight and the areola can be large with herniated tissue. A formal exam is critical to assess the appropriate operation. As for volume, it depends upon the exam. Fat injection may or may not help.
Options to fix tuberous breast deformity
It can be very confusing for someone who has a tuberous breast deformity and is told different ways to fix it by different plastic surgeons. However, plastic surgery is unique in that there sometimes can be many different ways to solve a problem and each surgeon may approach it in a different way.
Here are some points to guide your decision:
- No one can advise you without actually seeing and examining you since there different degrees of tuberous breasts and asymmetries and some options more aggressive than others.
- Your surgeon should be certified by the American Board of Plastic Surgery and have significant experience in complex breast surgery and revisions.
- You have to be comfortable with the plan and it needs to make sense for you. All the options mention are okay but only one may be right for you.
Consider expander implant for tubular breast correction
Your description sounds like a classic tuberous or tubular breast. Because of the short distance from the nipple to the bottom fold, it is very difficult to get a nice shape because the skin is tight. You are correct in being concerned about a double bubble. One option that I have found useful in cases like this is an expander implant (Spectrum from Mentor) that is a saline implant slowly expanded over a period of a few months. This helps to stretch out the bottom part of the breast for a nicer shape.
Without examining you and seeing pictures it is difficult to be specific about the best way to treat your breast deformity. It sounds as if you have a condition named tuberous breasts which is a constriction of the breast combined with deficiency of breast tissue usually in the lower half. The nipple areolar complex may be protruding and there is usually asymmetry of size.
I would consider doing a donut mastopexy with internal release incisions of breast tissue as well as adjusting the breast fold and using sizers to try as determine the best volumes to obtain symmetry possibly with different implant sizes. This can be a challenging problem and ask your surgeons to see examples of other patients he has treated with tuberous breasts. Best Wishes