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

I had my heart set on going under the muscle. I want natural looking results. I was originally quoted on going under the muscle and now it has changed to over to "achieve a better shape". I have seen a ton of great results of women like me who have gone under the muscle. I am having a very difficult time finding any information or photos on anyone with tuberous breasts that have had implants over the muscle. Please help. *Note: Tissue expansion etc is also being done, not just an implant.

Doctor Answers 14

Tuberous breasts

July 2nd, 2014
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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.
Edwin C. Pound, III, MD
July 2nd, 2014

Tuberous breasts

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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.
Edwin C. Pound, III, MD

Breast Augmentation with Mini Ultimate Breast Lift™

August 4th, 2014
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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.

Web reference: http://www.fastcodesign.com/1663319/how-one-surgeon-is-reinventing-the-female-breast-sfw

Gary M. Horndeski, MD
August 4th, 2014

Breast Augmentation with Mini Ultimate Breast Lift™

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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.

Learn more: http://www.fastcodesign.com/1663319/how-one-surgeon-is-reinventing-the-female-breast-sfw

Gary M. Horndeski, MD

Tuberous breast

July 14th, 2014
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I would sit down and discuss what you are trying to achieve, tell you the options available and then formulate a 0plan to address your expectations!
Edward J. Domanskis, MD
July 14th, 2014

Tuberous breast

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I would sit down and discuss what you are trying to achieve, tell you the options available and then formulate a 0plan to address your expectations!
Edward J. Domanskis, MD

Breast implants under the muscle are possible for tuberous breast

July 13th, 2014
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I agree with you that placing your breast implant beneath the chest muscle is the best option.

Typically a dual plane approach is used, the breast is dissected off the muscle and the constricting vertical bands are released.  Following this a sub-muscular pocket is dissected and the implant is placed beneath the muscle.  This is called the dual plane approach.  In my experience this works very well with tuberous breast.

You may likely need a lift of the left breast which can be done to the periareolar approach.

Web reference: http://www.bostonplasticsurgeryspecialists.com/services/breast-surgery/tubular-breasts/

Brooke R. Seckel, MD, FACS
July 13th, 2014

Breast implants under the muscle are possible for tuberous breast

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I agree with you that placing your breast implant beneath the chest muscle is the best option.

Typically a dual plane approach is used, the breast is dissected off the muscle and the constricting vertical bands are released.  Following this a sub-muscular pocket is dissected and the implant is placed beneath the muscle.  This is called the dual plane approach.  In my experience this works very well with tuberous breast.

You may likely need a lift of the left breast which can be done to the periareolar approach.

Learn more: http://www.bostonplasticsurgeryspecialists.com/services/breast-surgery/tubular-breasts/

Brooke R. Seckel, MD, FACS

Tuberous breasts

July 6th, 2014
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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.
Mark Deutsch, MD
July 6th, 2014

Tuberous breasts

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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.
Mark Deutsch, MD

Tuberous breasts

July 5th, 2014
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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.
Ronald J. Edelson, MD
July 5th, 2014

Tuberous breasts

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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.
Ronald J. Edelson, MD

Breast augmentation in tuberous breasts

July 5th, 2014
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I would agree with Dr. Pound and Dr. Corbin. You do have tuberous breasts but I have found it is difficult to predict how much they will expand and be corrected by an implant alone, but some of them do without the need for a periareolar mastopexy. I would agree also that the implant should be in the subpectoral position for all the many advantages of this approach. The constriction doesn't change this although it is all the more important to perform a dual plane release of the pectoralis muscle and fascia out of the lower pole of the breast. If the areolar constriction around its base is still apparent after an augmentation with a subpectoral, dual plane release then I would consider the periareolar mastopexy as a subsequent procedure. This is one of the situations where a true mastopexy is not needed and a periareolar mastopexy is all that is needed to correct the residual constriction. Whether it is needed and how much can best be determined after the augmentation. 
Scott L. Replogle, MD

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

July 5th, 2014

Breast augmentation in tuberous breasts

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I would agree with Dr. Pound and Dr. Corbin. You do have tuberous breasts but I have found it is difficult to predict how much they will expand and be corrected by an implant alone, but some of them do without the need for a periareolar mastopexy. I would agree also that the implant should be in the subpectoral position for all the many advantages of this approach. The constriction doesn't change this although it is all the more important to perform a dual plane release of the pectoralis muscle and fascia out of the lower pole of the breast. If the areolar constriction around its base is still apparent after an augmentation with a subpectoral, dual plane release then I would consider the periareolar mastopexy as a subsequent procedure. This is one of the situations where a true mastopexy is not needed and a periareolar mastopexy is all that is needed to correct the residual constriction. Whether it is needed and how much can best be determined after the augmentation. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

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

July 3rd, 2014
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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.

Web reference: http://www.poustiplasticsurgery.com/Procedures/Procedure_tubularbreasts.htm

Tom J. Pousti, MD, FACS
July 3rd, 2014

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

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Learn more: http://www.poustiplasticsurgery.com/Procedures/Procedure_tubularbreasts.htm

Tom J. Pousti, MD, FACS

Over or under muscle with tuberous breasts

July 2nd, 2014
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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
Marialyn Sardo, MD
July 2nd, 2014

Over or under muscle with tuberous breasts

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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
Marialyn Sardo, MD

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

July 2nd, 2014
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    Either is acceptable, and a good result can be generated with either approach.  I usually place the implants under the muscle.

Kenneth Hughes, MD

Los Angeles, CA

Web reference: http://www.hughesplasticsurgery.com/breast-augmentation-photo-galleries.php

Kenneth B. Hughes, MD
July 2nd, 2014

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

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

Kenneth Hughes, MD

Los Angeles, CA

Learn more: http://www.hughesplasticsurgery.com/breast-augmentation-photo-galleries.php

Kenneth B. Hughes, MD

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.