I Have Tubular Breasts and Was Told to go Over the Muscle, is this the best option for me? (photo)

I've been to two different surgeons and both said over the muscle and also both want to do a periareolar incision. Is that really my best option? I'm scared of capsular contraction and would have rather an inframmary incision/ under the muscle. Is that even an option for me? Thanks

Doctor Answers 12

I Have Tubular Breasts and Was Told to go Over the Muscle, is this the best option for me

Hi... Thank you for the question, yes you do have tuberous breast... the best way to treat this is with a BA, i suggest over the muscle to, and with the periareolar incision a Mastostomi ( treatment of the mammary gland) can be perform to improve breast shape. 

Dominican Republic Plastic Surgeon
4.6 out of 5 stars 74 reviews

Tuberous Breast Correction


Thank you for the question and photo. It is best to examine you in person before advising a specific surgical plan. In many cases of tuberous breast correction, implants are placed over the muscle in order to better communicate with the tissue and fill out a desired shape for the breast. I recommend that you share your concerns with your Plastic Surgeon so that you can ensure you are on the same page.

All the best

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Tubular breasts

With tubular breasts such as yours, in my opinion, it would be difficult if not impossible to do what needs to be done to enlarge the base of the breast from an infra-mammary crease incision. When we don't know where the crease will end up and we have to lower it, it is difficult to predict where to place that incision such that it ends up in the crease. Usually, some reduction of areolar size as well as a setback of the herniated gland is  necessary to change the shape from a pointed breast to one more rounded. Since were already making a circular incision for the areola, this incision can likewise be use to place the implant. I ,however ,do not feel that a sub glandular approach is necessary. With a dual plane placement and dissection of the muscle medially high up about the level of the top of the areola, as well as taking the breast parenchyma off of the inferior border of the gland, the bottom of the implant can sit in the exact same pocket as it would on top of the muscle yet be covered in its upper two thirds still by muscle keeping the advantage of better coverage and less capsular contracture. All surgeons have developed different ways of doing things so there's really no wrong answer here. Good luck with your surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

I have tubular breasts and was told to go over the muscle, is this the best option for me?

Thank you for your question. In some cases the periA incision is the best and same with over the muscle. In some cases it is dependent on your anatomy or the look you want. It is not possible to answer your question without an in person assessment. Speak to the surgeons to understand why they have decided on these approaches. 


Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 469 reviews

Different approach

I offer my patient with similar issue fat grafting and circumareolar reduction . You have very small amount of breast tissue to cover  over the muscle implant. Fat grafting will build up the soft tissue so you can get implant lateron if you want more one cup enlargement. Please see the link.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

Tubular breasts and #inframammary incision

The decision for over or under muscle for #tubularbreasts depends on how much natural soft tissue that your have. The scoring of the base breast tissue needed to expand your base would mean that I would recommend above the muscle, unless you are so very thin that you have minimal breast tissue. I would need to examine you to determine if you have adequate soft tissue.

In my opinion, you will require a periareola #mastopexy because once you place an implant you will probably have herniation of tissue through your aerola. That does not mean you have to place the implant through a periareola incision. You can still place the implant in the inframammary fold for #breast augmentation. It is definitely an option.

Jack Peterson, MD
Topeka Plastic Surgeon
4.5 out of 5 stars 41 reviews

Implants over the muscle

Your question is a good one.  First of all, even though under the muscle may be the preferred placement for a number of plastic surgeon, placing an implant under the breast tissue itself is also considered standard of care.  In your situation, I feel your surgeons have given you good advice since there may need to be other manipulation of the breast tissue to correct the shape of the breasts.  In addition, placing the implants closer to the area of problem or concern, may better help to correct the shape.

Roberta Gartside, MD, FACS
Reston Plastic Surgeon
4.8 out of 5 stars 27 reviews

Do I have to go over the muscle?

There are many different approaches to tuberous breast correction, and the aforementioned method is an extremely common one. Tuberous breast comes in a range of shapes and patients have varying priorities. I try to tailor my implant selection and placement, as well as incision based upon all of these factors. Each technique and approach has its advantages and disadvantages - during the consultation it is important to understand these so that the best decision can be made. I hope this helps. Good luck!

Bryan Correa, MD
Houston Plastic Surgeon
5.0 out of 5 stars 15 reviews

Tubular Breast and implants

Definitely, placement of the implants should above the muscle and an inframammary incision can be used since most of the correction and release of the tubular constricting bands are readily performed from this approach with excellent exposure. A much less visible scar is achieved without the worry of stretched visible peri areole scars. By the way, capsular contracture can occur below the muscle as well. Check with your board certified plastic surgeon about your options

Leon Goldstein, MD
Madison Plastic Surgeon
4.6 out of 5 stars 11 reviews

Tubular Breasts and Implant Placement?

Thank you very much for your question.

The implant can be placed either above or below the muscle, but more often (I think) the implant is placed above the muscle.  Many surgeons will place this through the periareolar incision, as often a doughnut mastopexy is also performed to contour the breast shape, so the implant is just placed through that same incision.

If you are concerned about a capsular contracture and don't mind an extra scar, you can have the implant placed through a breast fold incision, and placed in the subfascial (above the muscle, but below the muscle fascia) plane.  Then, the doughnut mastopexy can be performed to shape the breast and reduce the areolae.  By doing it this way, the implant doesn't come in contact with the breast ducts and capsular contracture should be reduced.

I recommend asking your surgeons about this possibility.

Best of luck!

Daniel Krochmal, MD
Chicago General Surgeon
5.0 out of 5 stars 24 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.