Tubular breasts, saggy, tight, constricted. Over or under the muscle implant?

Thank you for your question. I might disagree slightly with some others on here. And I am going to answer several of your questions together....

Shaped vs. round implant - this is up for debate, the honest answer is that either will work and some surgeons might have a preference for one or another. I actually prefer a shaped implant for these cases, especially if the patient has a severely deformed breast or very little glandular tissue. You want to make sure you choose a highly-cohesive gel implant, and now these come in both round and shaped, so there are options, but the highly-cohesive gel will help shape the breast over time, so whichever shape you choose, the shape of the final outcome will look more like the implant you choose (especially if you are small breasted to start out with). My preferred approach to a tuberous breast with enlargement of the nipple/areola is an incision around the nipple to place the implant (under the muscle usually, but this really depends on soft tissue/breast coverage thickness), scoring of the gland restriction in the lower pole, and then a periareolar mastopexy on the way out! But this same approach can be done with a shaped or round device.

Which implant type bounces/jiggles more softer? - my advice here is to choose a highly-cohesive gel implant, which is firmer but also ripples less and will do a better job at shaping the breast. If you choose a "softer" or less cohesive gel implant, the implant will be more likely to be shaped and formed by the breast than the other way around and this can be a problem when there is baseline shape deformity in the breast (tuberous breast).

Tubular breasts, saggy, tight, constricted. Over or under the muscle implant? - see above, in general the answer is under the muscle, but the implant can be placed over the muscle if you have enough natural soft tissue thickness and breast tissue to adequately cover the implant. If you do go in front of the muscle, I usually suggest using a textured implant (all shaped implants are textured) as the risk of capsular contracture is less with a textured implant than a smooth implant when placed in front of the muscle. This would need to be determined by an exam to find out what is best for you.

Hope this helps!

Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

It depends on the amount of constriction, perkiness, as well as other factors. More details would be needed. It may be possible to achieve satisfying results with placement over or under the muscle.

This is the route, in my opinion, for the most natural look- for any cosmetic breast surgery. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Almost all tuberous breasts will need reduction of herniated, large areola. For that reason circumferential scar around areola is standard approach. Significant shaping of breast tissue to neutralize narrow, tubular shape, is needed to create more natural breast tissue distribution. Placement of the implant is usually partially underneath the muscle. Good luck.

Dear Hepburnn,
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

For tubular breasts, you usually need a periareolar lift. Implant can be over or under the muscle, with partially under being the most common choice to reduce chance of capsular contracture and help fill out lower pole which is constricted.

An exam or photos is needed to give you the best recommendation. If you have tightly constricted, sagging tubular breasts you may need to consider a lift in addition to the augmentation in order to achieve a nice result depending on the degree. An implant can go above or below the muscle but below can give a little more support. See a board certified plastic surgeon near you to learn more.

You did not show photos, nor ask a specific question. Many women who think they have tubular breasts are only sagging. Tubular breasts are not really that common. I would suggest meeting with a board certified plastic surgeon and discussing your options. If you need a lift, the implant will go behind the muscle for better support.

Photos are absolutely necessary to answer your question. There are too many degrees of tubular breasts to properly answer without photos.
Dr. Taranow

Without a consultation, an accurate assessment of whether you would benefit from a breast lift, breast lift with implants, or breast augmentation with fat grafting or breast implants. The fat grafting/implants would add volume to your breasts, while the lift would resolve nipple and areola placement. That being said, having breast implants placed under the muscle would reap the most benefits. A Skype or FaceTime consultation with a breast augmentation specialist will help you get an accurate recommendation and pricing.

Respectfully,
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee