I have tubular breast, should I go under or over the muscle? (Photos)

Question

I Am getting 425cc silicone implants. Should I go over or under the muscle giving my constraints? The doctor will also release the food under the boob on the right one. Thanks.

John Michael Thomassen, MD · Answer

You appear to have thin soft tissues which makes the case for doing submuscular augmentation to avoid noticeable implants in the upper pole.

Itzhak Nir, MD, FACS · Answer

The treatment of a tubular breast deformity usually involves release of the gland tissue as well as reduction of the areola and placement of a purse-string suture. Implant placement position is the surgeons choice and I think that most surgeons these days would place the implant beneath the muscle if possible. I hope this has helped.

Don W. Griffin, MD · Answer

For correction of tubular breasts, I prefer to place the implant beneath the muscle. Remember that subpectoral placement only places the upper portion of the implant below the muscle, the lower part is not covered by muscle so it is in the same position as it would be for a subglandular placement. It is important to choose an implant size that fits your chest dimensions and not try to go too large as this can lead to all kinds of problems with the shape and look of your breasts. It is also important to release the constricting bands of tissue in the lower breast to allow the skin to stretch over the implant and not cause a crease or double bubble. Again, staying with a reasonable size implant helps with this as well. Many patients benefit from doing a periareolar or circumvertical mastopexy to elevate and diminish the size of the nipple-areola complex and improve the pointed shape of the breasts.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You do have tuberous breasts.  You are a great candidate
for a breast augmentation with release of lower pole constrictions 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.  There are several
advantages and disadvantages to over vs under the muscle.  Under the
muscle has the advantage of lower capsular contracture rates, less risk
of rippling, and better visualization with future mammograms.  Most
patients say that under the muscle also has a more natural look and
feel.  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

Richard Baxter, MD · Answer

Because one of the features of the tuberous breast is the very tight lower pole and short nipple-to-fold distance, I think that a form-stable implant is often the best choice. The muscle covers the upper portion of the breast, not the bottom where the issue is. For that reason I think the implant type is more important than whether it is over or under the muscle in this situation.

Reza Momeni, MD, FACS · Answer

Both are possible for treating tuberous breasts, but Without an exam, it will not be possible to fully evaluate you and give you recommendations.

Kris M. Reddy, MD, FACS · Answer

Based on the photos, you have soft thin issue as well as a tubular breast deformity. Therefore, it would be advisable to have a submuscular placement of the breast implants. Consult in person with an experienced and expert board certified plastic surgeon to understand your options.

Giovanna Ghafoori, MD · Answer

Hi, TBDProblem. Congratulations on your upcoming surgery!  Over or Under the muscle with a tuberous breast is a very difficult question!  
Generally, the dogma has been that a tuberous breast is addressed with putting an implant over the muscle, releasing the constrictions, and performing a "donut" mastopexy.  This approach provides the best opportunity to most thoroughly release the constrictions inherent in the tuberous breasts, to allow the implant to most thoroughly reshape and fill the gland, as well as to best reposition the protuberant, coned distal breast tissue over the implant and to cause some central flattening in order to reduce the excess coning that occurs with the tuberous breast.  Also, wide cleavage is also usually an issue with a tuberous breast, and implant placement above the muscle will slightly improve this issue, while placement under the muscle will aggravate it.
However, there is a higher risk of capsular contracture and/or hardening of the breast, the implant may be more visible and have more sharp border, the upper pole of the breast may not be as attractive, mammograms may be more difficult to perform, and the circulation to the nipple and breast tissue undergoes more disruption (that may be an issue with future surgeries).
In my area, many of my patients have tuberous breasts or a more mild variant, and I perform both techniques depending on their specific expectations and breast exam.  Your PS will be in the best position, based on his/her experience and training and your in-person evaluation, to make a good recommendation.
Best of luck to you, and I hope you achieve great results and have an uneventful recovery!

David Finkle, MD · Answer

A tuberous breast deformity usually consists of small cylindrical shaped breasts with large, out of proportion, areolas that can protrude (puffy).  The crease under the breast is high, the distance from the nipple to the inframammary crease is too short, making the breast appear "constricted".  The name arises because the breast resembles the shape of a tuber, an enlarged area of a root vegetable like a yam or sweat potato.The surgical correction consists of:Reducing the size of the areolaChanging the shape of the breast from cylindrical to round with implantsLowering the inframammary creaseReleasing the constricted band under the breastThe placement of the implant can be either over or under the muscle, depending on each individual and saline or silicone implants can be utilized.  It is an outpatient procedure and the recovery is similar to a breast augmentation.  Always, Always, Always see a Board Certified Plastic Surgeon with experience in tubular breast deformities to assure the best possible result.Good Luck!

Daniel Krochmal, MD, FACS · Answer

Thank you for your question.  Different surgeons have different preferences.  I prefer to place the implants overtop the muscle, and also do a donut mastopexy to make the breast more rounded (and less tuberous), and create a more aesthetically pleasing areola.  Again, different doctors have different preferences.  As long as your surgeon is experienced with tubular breast deformities, you should be in good hands.Best,Dr. Dan KrochmalMAE Plastic SurgeryNorthbrook, IL

I have tubular breast, should I go under or over the muscle? (Photos)

Answers (16)

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