Is it possible to correct constricted breasts without changing the nipple? (Photo)

Have constricted breasts/ aa / with slightly herniated nipples. 1-2 cm. I have surgery scheduled with the initial plan being to lower the inframmary fold to a normal level, then release the tissue and then place implants approx. 437cc at this time. My concern is the double bubble potential and chance of herniated nipples not rounding out. Any experience with this correction?

Doctor Answers 11

Correcting constricted or tuberous breasts

Based on your photos, you don't appear to have much herniating areolar tissue. In your case, again based on the photos, there appears to be a significant lack of breast tissue mostly in the inferior (bottom) and medial (middle) portions of your breasts. A small double-bubble is likely since one has to lower your inframammary fold, but this would be tolerable. Your nipples don't appear to be a major issue. Correction resulting in attractive breasts is definitely possible and a number of surgical approaches are possible to achieve this result. This can vary from a staged approach with 2 surgeries to a one stage approach using round or shaped implants. A staged approach uses tissue expanders to stretch the tissue before the final implant is placed, this is a form of breast reconstruction. Incisions can be made by any approach in cases where areolar bands do not have to be released. In my experience with breasts like yours, a single operation using anatomic implants provides the best results.


Las Vegas Plastic Surgeon
4.4 out of 5 stars 13 reviews

The constricted fold/tuberous breast dilemma and the best approach to correction

It looks to me like your main dilemma is a tight, constricted fold and breasts which are quite lateral.  There are several different approaches to correct this, each of which has its advantages and disadvantages.  However, what should be most important to you is what you will look like after surgery.  In my experience, the best determinant of this is your surgeon's previous results.   I often tell my patients that I am going to show them women who had similar breasts to start with, who had the surgery that we have been discussing and that if they don't like the way that patient looks, then either I am not the right surgeon for them, or we need to find a different surgical approach which will give them the results they want.  In other words, surgeon experience with these more difficult cases is extremely important - if a surgeon is unable to show you previous patients with the same breast you have pre-op and their outcomes after his surgery, he probably has not done enough of this type of case.

Constricted breast

Generally speaking, the implant should not change the appearance of the nipples.  If released fully, your chances of a double bubble are low.  Asymmetries are the most difficult obstacle to overcome in these surgeries.  The larger the implant, the more likely asymmetries will be evident.

Best of luck

Samer W. Cabbabe, MD, FACS
Saint Louis Plastic Surgeon
4.8 out of 5 stars 48 reviews

Correcting constricted breasts

Thank you for your question about your breast augmentation.

Your situation is fairly common.
The release of the constriction may not weaken the crease support -
If it does, your surgeon can place sutures to reinforce the crease at the time of your surgery.
The implant alone is likely to take care of the nipple appearance.
Photos can be misleading but if you are not fairly tall or very wide chested, the implant sounds too large.
In all breast implants, large an implant tend to cause more problems than smaller ones.


Always consult a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Constricted Breasts-release breast tissue, reposition of the IMF, release of herniated NA tissue & silicone gel breast implants

Constricted Breasts-recommend release breast tissue, reposition of the IMF, release of herniated NA tissue and silicone gel breast implants

I have had extensive experience with constricted breasts and revisional breast surgeries involving contracted breasts and capsular contractures of breast implants the present similar anatomical dilemmas as the constricted breast deformity.  

From your photos, not only do you have constricted breast, but you also have nipple/areola that are laterally positioned (off to the side of the chest).  In order to get the best shape of the breast with cleavage, upper/lower pole projection, as well as to control the shortened "crease", in my experience, it is best to place the silicone gel implants on the top of the muscle.  If the implants are below the pectoral muscle, then the shortened IMF crease, my not to "pressed on" enough to control it and the crease may persist and contribute to the "double bubble" result that is associated with an attempt to correct this constricted deformity.  I feel confident that using the Allergan Natrelle, textured, shaped 410 highly cohesive silicone gel implant (layman terms "gummy bear") would give a natural result on top of the pectoral muscle/under the breast.  To correct the lateral position of the N/A, it would be best to measure the chest width and be certain to use a wide enough implant to allow the N/A to "appear" to be more centralized, by creating lateral breast fullness.  

The pictures do not demonstrate a severe herniation of the N/A, but I would need to assess the correction of any herniation only after a physical exam.  

The constricted breast parenchymal release would need to tailored to the severity and tightness of the tissue and therefore the need for release and degree of necessary release can be assessed, once the implants are placed in the submammary pocket.  In my experience this is the best and most accurate approach and timing for the breast tissue release.

I think that you will have a good result if details to your unique anatomy are addressed at the time of surgery. 

Christine A. Petti, MD
Los Angeles Plastic Surgeon
4.4 out of 5 stars 18 reviews

Changing areola size?

Dear Littlern

It is exciting to finally correct an issue that has been on your mind for years! congratulations!

In my experience and based on your pictures, you do not need to revise the areola size. I think an areola incision with radial release of your banding and lowering of the infra-mammary fold will work nicely to give you an excellent improvement.
Although I dont know the dimensions of your chest, unless you are larger than average, 437cc implants might be a bit on the larger size in a one stage constricted breast reconstruction. Your surgeon has examined you and if he/she feels your constriction is not fibrous, this may not be an issue.

Afshin Parhiscar, MD
Bay Area Plastic Surgeon
4.9 out of 5 stars 49 reviews

Is it possible to correct constricted breasts without changing the nipple?

Thank you for the question. From looking at the photos I would agree that you have a tuberous breast deformity. I agree with comments made by dr Tom Pousti. In addition to that I would recommend to make sure that your plastic surgeon is board certified and performs both reconstructive and aesthetic plastic surgery. Good luck. 

Double bubble

Implants alone may work well for you. Even If your prior breast fold is released well then you may see a crease. This is usually not too much of an issue. Your size of implants is a bit big for your frame and may lead to a long tern unstable result. Good Luck!

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 53 reviews

Is it possible to correct constricted breasts without changing the nipple?

Thank you for the question and pictures.

Yes, I think your breasts do demonstrate some of the characteristics seen with tuberous (constricted) breasts.  As you may know, there are lots of variations of tuberous breasts.

Some of the characteristics seen with tuberous breasts include a very narrow base, short distance from areola to inframammary fold, tight (constricted) lower pole of the breasts, relatively wide space between the breasts, "puffy" areola and some degree of ptosis (drooping).  

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 breast implant positioning improves the distance (cleavage) between the breasts. The areola reduction helps to treat the pointed and "puffy" appearance of the areola.

In your case, if the appearance/shape/size of the breasts are a concern,  you may be an excellent candidate for corrective surgery.  Based on  your question and pictures provided,  a breast augmentation alone (without circumareolar incision) MAY serve to significantly improve the shape/contour of your breasts.    

 You may find the attached link, dedicated to surgical correction of constricted/tuberous breasts), helpful. Best wishes.

Breast

Based on your photos, I am not sure I would classify you as having "tuberous breasts".  They do appear very small and the treatment is the same regardless of the classification.  You also have the appearance of very thin tissue coverage.

You are an excellent candidate for textured shaped cohesive gel implants placed on top of the muscle (subglandular or subfascial) with immediate fat grafting.

These implants would provide the most natural appearance and can control the new shape and volume.  The fat grafts would provide additional soft tissue coverage.  Donor fat can be obtained from the abdomen or flanks in most patients.

Steven J. Smith, MD
Knoxville Plastic Surgeon
4.7 out of 5 stars 18 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.