I have tuberous breasts. Would you place an implant over or under the muscle? (photos)

Tuberous breasts are defined by two main characteristics:  1. a tight constricting "band" encircling the base of the breast and causing it to be narrowed and 2. an enlarged areola.  You have both of these characteristics.  I do NOT think that you necessarily  have any asymmetry.  I think it may look that way simply by the way your picture is taken.  In my hands, I would suggest a peri-areolar (aka, donut or Benelli) mastopexy to keep your areolae from expanding further after breast augmentation.  This would also help elevate your areolae slightly.  The constricting bands could also be addressed through this approach.  Finally, I would put your implants under your chest muscle.  I feel like the long term results would be better with submuscular placement as you appear to have minimal breast tissue coverage.  Also, submuscular placement would decrease your risk of capsular contracture.

I
recommend a new technique called Breast Augmentation with Mini Ultimate Breast
Lift™.Using only a circumareola
incision it is possible to reshape your breast tissue creating upper pole
fullness, elevate them higher on the chest wall and more medial to increase
your cleavage.Through the same
incision, implants can be placed.Aligning the areola, breast tissue and implant over the bony prominence
of the chest wall maximizes anterior projection with a minimal size
implant.Small round textured silicone
gel implants placed retro-pectoral look and feel more natural, are more stable,
less likely to ripple or have complications needing revision.Implant profile is irrelevant in the
retro-pectoral position since the muscle compresses it.A tissue expander is only necessary if you
want large implants otherwise a small implant can be done simultaneously.Best Wishes,Gary Horndeski, M.D.

I prefer the implant under the muscle in most cases.  Your left breast would require a lift to make it look right, so I would actually lift both breasts with the lollipop lift and put implants under the muscle.

    Either is acceptable, and a good result can be generated with either approach.  I usually place the implants under the muscle.Kenneth Hughes, MDLos Angeles, CA

Your breasts are significantly asymmetric. The left is more tuberous than the right-- I would approach your condition with a infra-areolar incision on the right with a high profile  Silicone gel over the muscle. On the left-- I would use a Supra-areolar incision with a crescent lift to achieve symmetry of the nipple with the right side. Simultaneously on the left- I would reduce the tuberosity from  the inside. And place the high profile implant-once again over the muscle.

Thank you for your question. You need to understand that tuberous breast deformity is a difficult and challenging problem and needs to be addressed in a careful manner. Although you may have implants placed under the muscle you would need a dual plane approach anyway to release the tight constricted breast tissue. You have some nipple asymmetry and you will need a breast lift to match the two breasts. A tissue expander placed initially will allow you to have a larger implant later. It is important that you seek consultation with a board certified plastic surgeon who has extensive experience with tuberous breasts to achieve the best result.

Thank you for your question and pictures.
Your picture demonstratesasymmetric breast ptosis along with constriction/tuberous anomaly.
Tuberous breasts  generally have a very narrow base and usually a long skin envelope. In the most severe cases of tuberous breast, a breast lift can be done through an incision around the areola, making the breast into a more rounded shape that the patient will be happy with. In many cases however, a lift is not necessary.
You should be aware that the final result will take months to see and that you will need to be patient.
The incision is usually confined to around the nipple/areola and may require a vertical/horizontal incision (in some cases) as well. The procedure involves making internal incisions to release the tight breast tissues, making a larger space for an implant, rounding out the lower breast crease, and correcting enlarged and protruding areola.  The space between the breasts ( cleavage area)  can be decreased with the use of implants as well.  I usually place the breast implants in the sub muscular (dual plane) position. I also prefer the use of silicone gel breast implants for most patients who present with constricted/tuberous breasts.
Make sure that your surgeon has significant experience with this specific procedure.  I hope this, and the attached link (dedicated to tuberous/constricted breast concerns) helps.

Satisfactory correction of tuberous breasts can be accomplished with implants placed under or or over the muscle . I prefer under the muscle (dual plane) for the benefits of less risk of rippling and capsular contracture , and generally a better long term result

Hello, Thanks for your question, and quite a good one by the way. The surgeon that did your evaluation is right: to treat constricted (tuberous) breast, the constricting rings need to be destroyed and the implant will help maintain this condition. If placed under the muscle, the rings might scar back to a constricting condition and you'd have a small tuberousity in front of your breasts, which is not consider an aesthetic outcome. Very natural outcomes can be achieved on tuberous breasts with lower projection implants. that way they won't appear as much as a high projection implant on your upper pole, and still to the job of reshaping your breasts. Any other doubt about this, feel free to contact me. Take good care of yourself, Dr. Fernandez Goico

Thank you for your photos and I routinely treat patients similar to yourself with a circumareola mastopexy and dual plane (Submuscular) placement of implants with excellent resultsDr Corbin