Will periareolar mastopexy help prevent double bubble in (mild) tuberous correction? (Photos)

My PS strongly suggested I get a perioareolar mastopexy tho I'd strongly prefer not to. Happy with my nipples, just trying to correct breast shape (200 mod+). But it might make sense that he'd want to flatten the nipple to cover existing constricted crease, since he's lowering the fold? and somehow maybe even help prevent double bubble? Can't recall what he explained.. hoping someone can fill in the blanks, or other insight on how to avoid possible double crease/bubble in tuberous corrections?

Doctor Answers 7

Double bubble and tuberous

A tuberous breast is at a higher risk for a double bubble because the lower pole is often tight and the fold high.  


New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Dr Kayser

Thank you for your question. Perhaps it would be helpful to understand the current condition of your breasts. The normal breast has different shapes which includes contour and shapes that are in proper relationship with the nipple being relatively centrally located. In your case, the development of your breast is not necessarily abnormal but is somewhat compromised where the distance between the nipple and the natural breast fold is shorter than usual.  It is this situation where placing an implant will create a double bubble. This does not have anything to do with the size of the areola or subsequently reducing it. In your case, because the distance between the nipple and the fold is so short, ANY implant will potentially violate the fold and create a double bubble. Reducing the areola will help to decrease the herniation or bulging that is often associated with constricted or tight breasts but this will also decrease the distance between the nipple and the fold, thereby, increasing the risk of having a double bubble deformity. Because of this, I would certainly encourage you to use very small implants and not perform a lift as you will need all the skin from the nipple to the fold that you can get. Once your implant is placed, the skin will stretch over time and, at a later time, may be more receptive to performing a reduction of the areola. Scars placed around the areola will be permanent but, in a situation such as yours, may actually expand because of the placement of an implant... it is important to understand that reduction of the areola  reduces the skin envelope which is exactly opposite of what is happening when an implant is placed  - stretching it in the opposite direction. These are two opposing forces which, in a situation like yours, can be very challenging. I would certainly encourage you to simply go with the implant only and leave the areolae procedure for another time. One final alternative would be to consider external breast expansion with what is referred to as a Brava Dome after which, fat transfer could be placed giving you a completely natural breasts. It would be important to understand that with this negative pressure device, enlargement of the areola may occur, however, this will likely decrease over time and if it doesn't, you are always left with an option of having it reduced surgically should it be bothersome to you. I would certainly consider these alternatives as you further discuss your situation with your plastic surgeon. I hope this helps and have a wonderful day. Dr. Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
4.9 out of 5 stars 31 reviews

Will periareolar mastopexy help prevent double bubble in (mild) tuberous correction?

Hello dear, thanks for your question and provided information as well..
The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift. A breast lift restores a firmer, perkier, and more aesthetically pleasing shape to sagging breasts. This not only can improve a patient’s appearance by restoring her youthful, feminine proportions, but  also help bras and swimsuits fit more comfortably and attractively. By removing excess, stretched out skin, reshaping the breast tissue, and raising the nipple & areola into a more forward position, a cosmetic surgeon can create a more youthful breast contour. Stretched, large areolae can also be reduced during breast lift surgery, creating an overall better proportioned, natural looking breast, Actually the perkiness on a person or another, depends on patients skin and breast tissue!

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.6 out of 5 stars 359 reviews

No need for mastopexy

Based on your images, I do not think there is a need for a peri-areolar mastopexy.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with and who is a board-certified Plastic Surgeon certified by the American Board of Plastic Surgery. Best wishes! Dr. Desai
Harvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Your breasts

Go for a second opinion. Your breasts really don't look tubular -- it might be possible just to do a sinple augmentation. 

William B. Rosenblatt, MD
New York Plastic Surgeon
4.1 out of 5 stars 11 reviews

Breast augmentation

Hello and thank you for your question. Based on your photographs, you are a great candidate for a breast augmentation.  The key to preventing a double bubble in a patient with lower pole constriction is to break apart the constriction bands when performing your surgery.  The size of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 80 reviews

Needs a periareolar mastopexy

From your photographs, I would strongly agree with your plastic surgeon that you would do better with a peri-areolar mastopexy and implants. With this small base of your breasts, and the necessity of putting in a larger implant  than would otherwise fit, the surgeon will need to lower the crease of your breast. In my experience, lowering the crease more than a centimeter and a half, greatly increases the risks of a double bubble. Therefore, if you can raise the nipple a centimeter and a half, that's less lowering that's necessary to accommodate a larger base implant. The peri-areolar mastopexy also has the advantage of creating a more rounded from a more pointed breast. When done well, the scars are never an issue. Good luck on your surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 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.