What approach would you suggest for breast reconstruction for Grade III tuberous breasts? (Photos)

Question

I'm 36 years old and have always felt like my breast were unattractive and like they never fully developed. I would like to get surgery, but I've had several consultations with very different approaches suggested. I am athletic so I would prefer only to add enough volume to give me a beautiful breast shape and I don't care to have fake-looking projection or breasts too far apart. What approach would you suggest?

Gianfranco Frojo, MD · Answer

This is a complicated question to answer. The inframammary approach (in the breast fold) is without a doubt the best incision for breast implants with respect to decreasing risk of capsular contracture and long term problems. The traditional teachings for this is to use an incision around the bottom of the areola. I would recommend using an incision in the breast fold as this provides optimal visualization and the least amount of risk for contamination with dirty skin around the nipple areolar complex. I would recommend seeing a board certified or board eligible plastic surgeon with aesthetic surgery training/experience who can perform a full exam and provide safe recommendations.

Wess Cohen, MD · Answer

Thank you for your question. There are a couple maneuvers that need to be undertaken to fix a tuberous breast. Do you need an incision around the areola to access the breast pocket. Then the constriction bands in the lower part of the breast need to be released as the brass fault is higher than its normal position. Additionally your breasts are sitting far apart so some construction bands would need to be Released towards your sternum as well this would create enough space to place a small to moderately sized implant, either silicone or sailing. Either at this time or as an additional stage in order to put a smaller implant in as well as to soften the shape of the breast you can undergo fat grafting As a highbred type procedure. Good luck.

Gerald Minniti, MD, FACS · Answer

We have held on tightly to the concept of simultaneous implant placement and circumareolar lift, but this 'gold standard' has an 80% complication rate requiring revision surgery. Instead, a planned second operation will accomplish much more than an unplanned one that is dealing with complications. Careful selection of implants is necessary and should not be unduly influenced by patient aesthetic goals, which tends to push the surgeon into using larger implants; excessively large implants leads to most of the problems and reoperations. The first surgery should involve placement of the implants, and ideally, fat grafting to the inner and lower poles of your breasts. A second surgery performed later when your breast tissues are no longer tight (9 to 24 months) would include the appropriate breast lift to create an optimized result, not necessarily a circumareolar lift. The delay in the breast lift will allow the surgeon to place the nipple areolar complex in the optimal position with the least amount of tension.

Gary M. Horndeski, MD · Answer

The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, fat transfers or small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

A lollipop lift with implant can place the nipples where they belong and give a nice result. Do not try a donut lift. It won’t reposition your nipples properly

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. 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, and they choose what looks right for them. 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. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Daniel Barrett, MD · Answer

Dear MarschinoCognac,
tuberous breasts are not simply small or underdeveloped breasts. The appearance of the breast can range from mild to severe, and typical traits include: enlarged, puffy areola, rather wide spacing between the breasts, very little breast tissue, sagging, higher than normal inferior breast fold, and narrow base at the chest wall.The type of surgery best for you will depend on the severity of your condition.My preferred technique for tuberous breast correction involves a multistep procedure where the breast tissue is released in a radial pattern to prevent herniation into the areola and placement of a custom implant size is in the breast to allow appropriate expansion of the breast in the restricted dimensions. This can often be done in a single procedure but sometimes may require two surgeries.That said, it is best that you visit a board-certified plastic surgeon for an in person examination. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ram Kalus, MD, FACS · Answer

Thanks for your question and photos. An examination in person would be required to properly evaluate you, however several important points are worth emphasizing. Even though you are not pleased with the appearance of your breasts, please know that they are “normal”, even if not ideal aesthetically from your perspective. It appears that you have a constricted lower pole, widened areolae, and overall relatively small volume, the latter two features contributing to the relative lack of cleavage.

The basis of your correction needs to be a reduction of your areola diameter, a breast augmentation with wide enough implants to give the appearance of enhanced volume and cleavage, as well as lengthening of the lower pole or lowering of you inframammary fold. This can be accomplished in one stage or two. Please consult with an experienced board certified plastic surgeon whose results appeal to you based on his or her Before and After gallery. Best of luck to you.

Justin K. Williams, MD · Answer

The approach to surgical treatment of tuberous breast deformity is well described in the plastic surgery literature. The problem involves an abnormally constricted lower portion of the breast as well as herniation of the breast gland into the areola. Surgical treatment involved treatment of these particular issues. It usually involves an approach around the nipple where the lower portion of the breast is released to allow more space for an implant to be placed. Usually excess areolar skin is removed during this technique. The result is a natural appearing breast with nice shape and the problems of tuberous breast corrected. Please see our attached link for more information.

Camille Cash, MD · Answer

From your photos it appears you would benefit from an augmentation with implants and a periareolar lift with areola reduction.  This would give better shape to the breasts, including more upper pole fullness.  It would also reduce the diameter of the nipple/areola complex as well as lift the position of the nipple.  See a board certified plastic surgeon near you to learn more.