Tuberous breast augmentation without a lift? (Photo)

Question

Hello! I’m just wondering if it would be possible to achieve nice round breasts without getting a lift? I’ve heard it’s common for tuberous breasts to need a lift but I feel like I don’t have much to lift. Would making my crease lower instead of a lift take away the tuberous look? Do I NEED a lift?

Robert M. Tornambe, MD · Answer

I appreciate your concerns, but you do have options.
 Your photos demonstrate moderate signs of tuberous breasts with fairly significant lower pole constricted breast tissue. It appears that your best option would be placement of implants beneath the muscle and release of the lower pole constricted breast tissue, which in your case would lower your inframammary folds. The implants are needed to maintain the improved shape of the breasts and prevent the lower pole breast tissue from becoming constricted again. Either round or anatomical implants would be suitable. This approach should have no effect on nipple sensitivity or breast-feeding. Be certain to consult with a board-certified plastic surgeon with lots of experience with constricted breasts. Good luck.

Christopher Costa, MD, MPH · Answer

In your case, the "lift" part of the procedure would be to correct the herniation of breast tissue coming through your areola. It is more to augment your natural tissue to get your nipples to appear more condensed and loosen the constricted tight breast parenchyma. It would be a necessary part of the procedure to get you the desire result, given the extend of your tuberous breasts.

Leila Kasrai, MD, FRCSC · Answer

It’s difficult to give you an opinion based on your photo. You do appear to have tuberous breasts, and the constricted tissue will need to be released before implant insertion. However, whether you need a lift depends on the location of your nipples in relation to your breast fold. If they are below and are pointing downward, then a lift is recommended.

Kevin Mosca, DO · Answer

Thank you for your question. The tuberous breast correction really depends on the grade of tuberous breast. In your case you have a high riding Inframammary Fold and Nipple Herniatio of tissue. For this case you may not need an entire life with vertical scarring. We would typically perform a dual-plane aug with the incision lowering the fold and a periareolar reduction scar to reduce the herniated tissue and cone shape. With some radial scoring it will help round out the tissues.

Gary M. Horndeski, MD · Answer

Many women do not like lifts because of the vertical scars associated with the traditional techniques. The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, small implants or fat transfers can be performed. Implants are not lifetime devices. 8% fail within the first year and 30% fail within six years. Fat transfers are permanent and incorporated into the body.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend consultation with a plastic surgeon to be measured and discuss your goals. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. You should also be aware that results of surgery can change in the future with significant weight change and/or stretching of skin from the milk of pregnancy. Unfortunately, surgeons have created the term tuberous breasts, a fact which causes unnecessary concerns for women. Many women just have different sizes and shapes and in my opinion shouldn't be labeled. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame. Philadelphia, Pa., USA

Donald R. Revis Jr, MD · Answer

Good afternoon!
I would recommend that you have a donut mastopexy and submuscular augmentation with saline or silicone gel implants, placed under the muscle, would be the way to go. We would figure out the exact size and profile when I measure your chest, we review photos together, and you have an opportunity to try on the implant sizers here in the office! The donut mastopexy isn't so much because you are saggy or need a lift, but it is used as a way to correct the way your natural tissue is herniated into your areolas- the so-called puffy nipple look. Otherwise if you only do an augmentation the puffiness will remain and your breasts will look like a sundae with the puffy nipple being the cherry on top!

Ram Kalus, MD, FACS · Answer

Thank you for your question and photo. The only reason you may need something other than a properly planned breast augmentation is if you feel your areolae are wider than you would like. This can only be corrected with an areolar reduction, which is a variant of a "breast lift" even though the breast may not be lifted at all.

Your photo reveals that you have a slight breast asymmetry  in terms of size and position of your breasts on your chest, but this is entirely on the spectrum of "normal", even if you are not satisfied with the appearance of your breasts. That said, a precise treatment plan can only be devised or recommended after an evaluation in person by a board certified plastic surgeon. Your breasts indeed appear to be tubular, meaning they have a short distance from the nipple to the bottom of the breast, and your inframammary fold would definitely need to be lowered in planning your breast augmentation. You have a fairly wide distance between your breasts so your aesthetic goals needs to be clearly discussed with your surgeon. I always recommend the use of photos to illustrate to your plastic surgeon your goals. The wider your implants, the greater degree of cleavage But if you want both width and projection you will require fairly large implants, which may be larger than advisable.

Do your research, and be open to the possibility of more than one consultation if necessary to feel confident about moving forward.

Daniel Barrett, MD · Answer

Dear Knicolebk,
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

Vishnu Rumalla, MD · Answer

Thanks for your inquiry, the peri-areolar lift is added along with dropping the crease to centralize the nipple, free the surrounding breast from the nipple areolar complex and to reduce the protrusion/herniation of breast tissue.  Good Luck.