Are my breasts tuberous or just saggy? (Photo)

Question

My breasts are asymmetrical and one side is smaller than the other. My nipples are also puffy and sit low, and my breasts are more long than round. Are my breasts tuberous or they're just saggy? If I want to improve the appearance, would a minor areola reduction help with the fat distribution? I'm not looking to get a breast lift as I'm not keen on the scars it will leave. I'm also planning to get breast fat transfer to increase/even out the size.

Daniel Barrett, MD · Answer

Dear Brave107311,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Brian Bassiri-Tehrani, MD · Answer

This is a great question as this can be a very subtle but important point.

When it comes to tuberous breasts, it can be on mild, moderate or severe. In your case, it appears to be mild, yet important to note. It does appear that one side is smaller than the other. Additionally, the breast crease on the small side appears to be higher than the larger side, which is typical in a tuberous breast. Although it is not as obvious as a severe tuberous breast, certain techniques can be performed to achieve a symmetric and harmonious result. Instead of a breast lift or areolar reduction, addition of volume with fat may help even out discrepancy in size.

Connie Hiers, MD, FACS · Answer

No, your breasts are not tuberous, shaped like tubers, but do have some sagging. A lift with a fat transfer would be best.

Mats Hagstrom, MD (license on probation) · Answer

A tubular breast is shaped like a tube.
It typically maintains the same diameter from its base through the length of the breast. It looks like a “tube”
Your breast is slightly narrow, but definitely tapers towards the nipple. Yours are more cone shaped than tube shaped. 
Unilateral fat transfer is probably your best option for obtaining better symmetry.
Make sure no fat is grafted in the larger breast or it will make the asymmetry worse.
The number of plastic surgeons who’ve mastered breast fat transfer is fairly low.Delivering consistent quality results for both liposuction and fat transfer is more difficult than most people realize.
Breast fat transfer typically increases breast size by about 1/2 cup when done by as sufficiently experienced provider rep.
This often equates to 50% or sometimes 100% breast increase in size.
To get your breast to be even in size will probably require two rounds of fat transfer.
Start with one and see how you like the results.
By far the most important variable is provider selection.
Finding the right plastic surgeon for this type of procedure is not easy or straightforward.
When reviewing it before, and after pictures, it is imperative to have a clear understanding of the timeframe of when after pictures were taken.
 Early fat transfer results can look extremely impressive but do not in anyway represent long-term final results.
Providers and patients alike may be tempted to want to take pictures a bit early because the results are so impressive during this time.
When reviewing before, and after pictures, never assume that results represent long-term final results especially if the results look too good to be true.
During in person, consultations, while reviewing before, and after pictures, ask each provider the exact timeframe of when after pictures were taken.
Pictures should be taken at least 3 to 6 months from the date of surgery in order to be representative.
 Pictures taken a few weeks after the procedure do not show what final results will be, but can look incredibly impressive 
Defined the right provider I suggest having multiple in person consultations with plastic surgeons in your community who seem to have a strong track record for this procedure.
Recognize that breast fat transfer is always to operations done at the same time.
The first is Liposuction, and the second is fat transfer.
You need to vet providers for both Liposuction, skill and fat, trans skill.
The importance of being in the hands of a provider who is skilled at both procedures is key.
 Poorly done Liposuction can leave people disfigured.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who had similar body characteristics to your own parent
If your goal is symmetry, then ask providers to show you all of their breast fat, trans symmetry cases.
For commonly performed plastic surgery procedures, I think an experienced provider should have no difficulty showing you the before, and after pictures of at least 50 previous patients.
Breast a symmetry is very common, and it is common to graft more fat on one side than the other repaired
Unilateral breast fat transfer, purely, for the sake of symmetry is not nearly as common.
Still, it is not an uncommon situation Especially for those who have expertise in the procedure.
You should also vent providers regarding Liposuction skills.
Whatever areas the surgeon recommends fat be harvested from you need to see an equal number of before and after pictures of the Liposuction results.
Being shown a handful of pre-selected images, representing only the best results of a provider career may be insufficient to get a clear understanding of what average results look like in the hands of each provider.
There’s no correct number of consultations needed to find the right provider.
The more consultations you scheduled the more likely or to find the better provider for your needs.
 Mastering both Liposuction and fat transfer is more difficult than most people realize.
The biggest mistake I patients make is first scheduling only one consultation, then scheduling surgery.
The second biggest mistake is assuming that somebody who is board-certified in plastic surgery with overall good reviews and several years of experience has mastered most plastic surgical procedures.
This is not true.
The number of plastic surgeon who have truly mastered this procedure is very small.
In the hands of the right provider, you should have a fairly good quality outcome if your goal is to obtain symmetry.
It may be a bit challenging to get perfect symmetry from a single operation.
It may require two rounds of fat transfer, but should not require more than that.
Best,
Mats Hagstrom, MD

Are my breasts tuberous or just saggy? (Photo)

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