What other approach/technique is recommended for mild tuberous breast other than a areolar reduction?

Im getting a BA. My doc said I have a mild tuberous breast. Areolar Reduction is recommended & the BA alone wouldn't fix it. Is there another way to correct the puffiness of the areola? I do not want to have a 2nd surgery later. If I do not go through w/the reduction, will the puffiness be very noticeable? I really want it fixed but the reduction scares me, the scars, possible stretching of the scars, assymtrey, & that look of the areola looking rippled and fake worries me. Am I overthinking it?

Doctor Answers 11

Tuberous Breast Augmentation


You are NOT overthinking these issues regarding breast augmentation in the tuberous breast.  In fact, these are very real issues that frequently require reoperation or 'minor adjustments', more common than breast augmentation in the non-tuberous breast.  Breast augmentation with areolar reduction are two opposing procedures: the implants enlarge the volume of the breast and stretch the already tight, inelastic breast skin, and the areolar reduction serves to reduce the areolar area, thereby further tightening breast skin that is already under tension.

It is not unreasonable to undergo breast augmentation without areolar reduction, with the understanding that a second surgery will be performed some time in the future, after the breast skin has expanded and relaxed.  Regardless of your breast shape, you should reconsider having breast augmentation if you do not accept the fact that a second surgery will be required sometime in the future, even without surgical complications.

Another word of caution.  As I previously mentioned, your breast skin is inelastic and tight, a hallmark of the tuberous breast, and it will not stretch that much.  If an inappropriately large implant is placed, your natural inframammary fold will lift off your chest wall creating a contour defect known as double bubble. Please limit the size of the implant, at least during the initial surgery.  Larger implants can be placed in a subsequent surgery without this problem.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

What other approach/technique is recommended for mild tuberous breast other than a areolar reduction?

The appearance of the areolar puffiness may be improved by performing incisions within the breast tissue just under the area of constriction around the base of your areolae. This will help to flatten the areolae. However, the width of the areolae will widen due to the release of constricted tissue and pressure from your breast implants. This would be the only way to avoid a circumferential scar around your areolae. Thank you for sharing your photos and question. Best of luck with your breast augmentation.

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 164 reviews

What other approach/technique is recommended for mild tuberous breast other than a areolar reduction?

Thank you for your question! Given your photos, I do agree that it does appear that you have a mild tuberous breast/constricted breast deformity. For such a deformity, the standard procedure would be placement of an implant (or tissue expander, depending on the lower pole of your breast) as well as a circumareolar breast lift. These modalities would correct the issues with tuberous breast: constricted breast at the inferior pole, via breast prosthetic; scoring of the tissue to release the bands; lowering the inframammary fold; correcting the herniation of breast tissue into the areolae; and decreasing the overall size of the areolae. These are the hallmarks of tuberous breasts.

While sometimes challenging to correct, I believe that you can get an excellent result, with your photos shown.  Consult with a plastic surgeon well-versed in breast surgery and discuss your goals and expectations. S/he will then be able to examine and discuss the various options and assist you in deciding which decision os the right one for you, given your desires. I would expect a very pleasing result for you! Hope that this helps! Best wishes for a wonderful result!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

What other approach/technique is recommended for mild tuberous breast other than a areolar reduction?

Thank you for the question and pictures.
Yes, I think your breasts do demonstrate some of the qualities seen with tuberous (constricted) breasts; there is a wide range when it comes to tuberous/constricted breast presentation.

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

In the most severe cases of tuberous breast, a more complete breast lift may also be necessary. In many cases however, a lift is not necessary. The patient should be aware that the final result will take months to see and that they will need to be patient and that revisionary surgery is more likely than in patients who do not present with tuberous (constricted) breasts.

In your case, if the appearance/shape/size of the breasts are a concern, you may be an excellent candidate for corrective surgery.
When you are ready, please make sure you consult with well experienced board-certified plastic surgeons who have significant (demonstrable) experience with this type of surgery.
I hope this, and the attached link (dedicated to corrective surgery for patients with tuberous/constricted breasts) helps. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,485 reviews

Tuberous Breast surgery

Tuberous breasts are tricky to fix.  However, if done well it can look like normal breasts.  The cause of the "puffy" areola is because there is herniation of the breast tissue into the areola along with a fascial ring around the base of it keeping the herniation there.  You can see this ring constricting at the base of the areola in the last picture, causing the herniation of the breast tissue into the areola resulting in the "puffy" look.  The treatment for tuberous breasts is an areolar reduction, scoring of the breast gland (release of the constriction ring), and placement of an implant above the muscle so that it stretches and forces the breast tissue to open up.  All these steps can be performed through an incision around the areola so the scars will be minimal.  Use of a permanent suture will prevent stretching, asymmetry, and widening of the scar.  Good luck and hope this information helps!

Roger Tsai, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 14 reviews

What other approach/technique is recommended for mild tuberous breast other than a areolar reduction?

There are several features involved in the description of a tuberous breast. The base of the breast is usually abnormally narrow. The inframammary fold is usually higher which results in a shortened distance between the nipple and the fold. This results in a constricted or tightened lower pole of the breast. The lower pole is the lower half of the breast. This constriction or tightened breast envelope causes the breast to push forward into the areola as it develops. The areolar skin is more elastic than the surrounding breast skin. Consequently as the breast develops and pushes forward into the areola the appearance of a "puffy" nipple areolar complex develops. This is often described as a "pseudo-herniation" of the breast tissue into the areola. The surgical correction of this problem will depend on how many of these components are present. Some patients present with mild deformities and some have all of the above described features. Correction of the pseudo-herniation of the nipple areolar complex often requires an incision around the areola removing extra skin and tightening the area. This is called a periareolar mastopexy. In order to widen the base of the breast it is often necessary to release bands that have formed at the base of breast allowing it to stretch out over an implant. An implant is normally required to achieve stretching of the base of the breast.Judging by your photographs I believe you with benefit greatly with the periareolar mastopexy (areolar reduction) component of the procedure. Good luck.

John J. Edney, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 112 reviews

Tuberous breasts

Consider the breast augmentation and areolar reduction as a 2 stage procedure.  Depending on how  big you go, the stretch from the implant may widen the periareoler  scar if done together.

Marshall T. Partington, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 80 reviews

You breast will look weird without areolar reduction

I do not believe that you are overthinking this....it is a very reasonable question. However, in your case breast augmentation alone without areolar reduction will probably not provide a very pleasing result. I would trust your surgeon's opinion on this.

Kevin Brenner, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 22 reviews

Tuberous breast

In order to optimize your results you should consider a mini breast lift. This should be done to not only reduce the prominence of your areolas but also to raise the nipple up to create more inferior breast pole room. The lift procedure that you select is also important as this will ensure a well healed areola. Please make a consultation to give you definitive recommendations.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 65 reviews


Thank you for the question and photos and YES you are over thinking it so don't be afraid of both procedures as performed in the hands of an expert should give you a beautiful result 

Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 61 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.