Do I truly need a nipple lift with tubular breasts? Can just implants, stretching the base and scoring help the shape? (Photos)

I treat most patients with tuberous breasts with augmentation only, taking care to score the lower pole to allow expansion of the lower breast. The breast shape improves noticeably over time in most cases, and patients are pleased with the results. I nearly never do breast lifts since, in the case of areolar reduction or donut mastopexy, the breast is flattened, the areola nearly always stretches back to its original size or larger, and the scars are often ugly. Any other type of lift will usually remove too much skin from the lower pole, which is tight to begin with. I do find that the tuberous breast tends to be overtreated. This is especially unfortunate, as patients are often young and are left with unnecessary deformities that can be difficult to correct. All the best.

The inferior portion of your breast does look constricted. I suspect that a breast augmentation with radial scoring/ release and lowering of your inframammary crease would give you a good result. Your tissue doesn't appear to be herniating into the nipple/areolar complex, which is sometimes seen with tuberous breast deformities, so an areolar reduction doesn't seem necessary. It is hard for me to tell from the pictures the degree of breast droop is present, so a small lift could potentially be beneficial. However, since you don't want a lift and you want to have kids, you could always reassess your breast shape/ nipple position after your augmentation and completion of breast feeding. 

At
29, women are concerned about breast feeding and the vertical scars associated
with the traditional techniques.  For
those reasons, a new technique was developed called The Bellesoma Method.  This will reshape your breast tissue creating
upper pole fullness without implants, elevate them higher on the chest wall and
more medial to increase your cleavage. 
Vertical scars are avoided, nipple sensation and the ability to breast
feed are maintained.  At the same time or
later, fat transfers can be performed if additional volume is desired.  Best Wishes,Gary Horndeski, M.D.

Dear tterhune3,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

Hello and thank you for your question. Your breasts do appear to be tuberous with lower pole constriction.  You are a great candidate
for a breast augmentation using a dual plane technique and release of lower pole constriction bands.  I do not think you will need a formal lift.  This entire surgery
can be performed with a small incision technique.  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. FACS
Harvard-trained plastic surgeon

Based on your description and pictures, either surgical approach is an option.  However, if you go with the non-lift approach, be cognizant that your nipples are still going to point downwards to a degree and sit lower (not centered) on the implant themselves.  You can only lower the fold and release the tissues so much.  If you are ok with that, at least until after having children, then that is the way to go.  I hope this helps.

I think the second surgeon option sounds good. Placement of implants and release the constricted bands. Make sure you see a board certified plastic surgeon. 

Given what you are saying about not wanting one and if you need it waiting until after kids it sounds like a no-brainer to me. The two step option offered by the second surgeon is clearly more consistent with what you want. The lift is only necessary if you have puffy areolas that bother you. If you just want a more rounded out bottom then the implants plus release of the construction bands should be just fine on its own. Hope that helps! 

the best option depends on your desired result. Implants alone with lowering the fold is a good option as long as you are comfortable with a lower riding breast. You would need a larger implant to fill the upper pole of your  breast due to the lower implant position. If you wish to be smaller, then you should maintain the natural fold level and raise the nipple/ areola to a position centered over the implant . Ask your surgeon to show photos to guide you on this decision.
Best Regards, Prashant Soni M.D.

Hi tterhune3, While tubular breasts may be deficient in size, they are not simply “small breasts” that have not completely developed. The characteristics of the tuberous breast deformity include breast constriction, breast hypoplasia (small breast size or underdevelopment), breast skin deficiency, malposition of the inframammary fold (the crease beneath the breast), areolar herniation (puffiness or bulging of the nipple-areolar area), and asymmetry. Women may have one, several, or all of these anatomic characteristics. TBD can not simply be corrected with a breast augmentation. Correction incorporates breast augmentation when necessary, but usually also requires a breast lift and areola reduction to achieve the most consistent aesthetic outcomes. Make sure your surgeon can show you the results they have a history of achieving in patients with anatomy similar to yours that back up whatever recommendation they may make. You then just have to make a choice and understand the realistic outcomes for your case. If you don't feel as though you've found a doc you can trust, go on more consultations. Good luck!