What is my Best Option for Augmentation with Constricted/tuberous/asymmetrical Breasts? (photo)

I am 5'4" 110lb and told I have asymmetry, lower pole constriction, & very mild tuberous breasts. 325cc smooth round silicone gel implants under the muscle with no lowering of the fold or lift of any sort was the recommendation. I would like a big as my frame can carry while still looking natural. Will end up looking worse or point/downward nipples with this option. What would you recommend for treatment options? The Dr. made me feel like I am a difficult case and shouldn't expect great results.

Doctor Answers 10

You Have Normal Breasts And Augmentation Alone Is Best

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Thank you for your question. You have very nicely shaped normal pretty breasts with a slight asymmetry. You do not have constricted inferior poles and you do not have a tuberous breasts.

A simple breast augmentation should give you a very nice result. If the slight asymmetry you have bothers you a small lift can be done on the right side for symmetry but I do not think it is necessary as most women have an asymmetry similar to yours.

Consult another surgeon and be certain to consult a plastic surgeon who is certified by the American Board of Plastic Surgery and who is experienced in cosmetic breast surgery. I do not view you as a difficult case and all.

One question I suggest that you ask your plastic surgeon is to discuss sub-muscular augmentation versus sub-glandular augmentation. Because of the slight amount of ptosis or sag on the right side a sub-muscular augmentation could push your nipple downward and risk a "snoopy deformity". This should be discussed with your surgeon and the question raised as to whether a sub-glandular augmentation is a better option for you.

Straightforward breast augmentation is right for you

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You judge yourself a little too harshly.Your breast is small and very mildly asymmetric, but not unlike so many. A straightforward augmentation will work out very well for you. As big as you can go? Buy the bra you want to wear (leave on the tags in case) and fill it out at home and try on all your clothes to see just how big you are comfortable with. When you find the right 'fit' maka sure your surgeon sees it.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Mild Tuberous Breasts

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Your breasts are very mild in the relation to tuberous deformity. In patients similar to you I have had good success using a periareolar incision, scoring the lower pole to help release it and using a high profile implant. As suggested below, a few more consults may help you to find the right operation for your anatomy and the PS to perform it.

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Constricted breasts

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You have constricted breasts with a negligible tuberous deformity.  Your case is not that difficult and you should anticipate a great result.  If your doc isn't optimistic about your result, you should consider another doc.

Tubular Breast?

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There are varying degrees of constricted breast deformities, the most severe of which is the tuberous breast. You seem to only have a mild constriction. Based on your comments, I would seek additional opinions before choosing your surgeon.

Tuberous breasts

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The degree to which you have tuberous breasts is very minimal.  Hard to advise re implant size without a physical exam, measuring your chest width, and assessing skin stretch/elasticity.  That being said 325 cc is a reasonable (but large) size in your case so do not expect a subtle result.

What is my Best Option for Augmentation with Constricted/tuberous/asymmetrical Breasts?

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Although your breasts are slightly asymmetric and somewhat lateral in position, I would not call these tuberous breasts. 

There are a number of features that define a tuberous breast:

  1. Wide and puffy areolae
  2. widely spaced breasts
  3. high breast fold
  4. constricted lower pole (deficient tissue in lower half of the breast
  5. minimal breast tissue
  6. narrow base of the breasts. 

Of these, only item #2 seems present on your photos.

Without an actual exam and measurement, I would hesitate to suggest an implant size. However, given your uncertainty, I think that getting a second opinion is a good plan. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Tuberous breasts

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Make sure you go to a plastic surgeon that does mainly breasts. I do a lot of tuberous breast and have very good results. Make sure your plastic surgeon specializes in breast surgeries. 

Norman M. Rowe, MD
New York Plastic Surgeon
4.9 out of 5 stars 62 reviews

Best option is simultaneous augmentation and lift

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The best technique for your condition would be Breast Augmentation with Mini Ultimate Breast Lift. Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage. Through the same incision, implants can be placed. Aligning the areola, breast tissue and implant over the bony prominence of the chest wall maximizes anterior projection with a minimal size implant. Small silicone gel implants placed retro-pectoral look and feel more natural, are more stable, less likely to ripple or have complications needing revision. Best Wishes, Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

What is my Best Option for Augmentation with Constricted/tuberous/asymmetrical Breasts? (photo)

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Thank you for your detailed information. I have to agree with your plastic surgeon. It is a difficult case and the size he has recommended is the maximum I would recommend. In addition to the points you have mentioned, your breasts are also wide apart, so creating a cleavage will be another challenge and may not even be possible. But, one thing I do not agree with, is the fact that you have a short inframammary segment (distance from your nipple to your inframammary fold), and a high chest. This means that you do need your folds to be lowered and that is the only way high riding implants and downward nipples can be avoided. Just make sure you are under the care of an experienced plastic surgeon certified by the American Board of Plastic Surgery who can show you an adequate number of sample photos of similar cases.

Ruben B. Abrams, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 19 reviews

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.