Tuberous breast correction - what treatment would you suggest? (Photo)

Question

Hello, I have had a couple consults to fix my tuberous breasts. I am very aware my deformity requires implants and I am ready to do so. One doctor said I needed implants, pocket revision and a peri-areolar lift and another doctor said he thinks implants plus the pocket revision is all I need because of how mild my tuberous breasts,my nipples not being lopsided or overly large/puffy. What would most suggest? I want to ensure my nipples won't look crazy after.

Elizabeth Kiwanuka, MD, PhD · Answer

In addressing tuberous breast correction, understanding that the best treatments hinge on the patient's aesthetic goals is key. When considering implants, it's important to note that the nipple-areolar complex (NAC) may enlarge and stretch due to the implant stretching the soft tissue above it. Consequently, without a lift, a larger implant might be required to adequately correct the tuberous deformity and achieve a more natural breast shape.
As you consider your options between the two surgical opinions&mdash;implants with pocket revision and peri-areolar lift versus just implants and pocket revision&mdash;it's crucial to define what your goal size is and how you envision your breasts post-surgery. This will significantly influence whether additional procedures like the lift are necessary to prevent the nipples from appearing disproportionally stretched or misplaced due to the underlying condition and the implants.

Gianfranco Frojo, MD · Answer

I would recommend a bilateral breast augmentation below the muscle and an areolar reduction. I would recommend always consulting with a board-certified plastic surgeon with 3D capability to show you the potential outcome.

Sean T. Lille, MD · Answer

Dear Angel_1009,,
I have treated many such situations over my 24 years of practice. I treat it like your first surgeon recommended, with implants, lowering the breast crease, scoring the breast tissue. Hence, it expands and the donut lift will correct the herniation of the areola. This will help it lie flat like most areolas do. If having your areola sit like a "Hershey kiss" doesn't bother you, then don't do that part. 
I have seen amazing results with this technique. 
Best wishes!

Gary M. Horndeski, MD · Answer

The size of your areolas are slightly large compared to the size of your breasts. You can do a circumareola incision to decrease the size and projection of your areolas. It may be possible to use an inframammary incision and place submuscular implants.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Gerald Minniti, MD, FACS · Answer

Your breasts are significantly constricted as evidenced by both severe glandular herniation into the nipple-areolar complex and a very short nipple to fold distance. You can't have a 'pocket revision' without already having had implants, so I don't know what they mean by that (unless they are already talking about a common complication with tuberous breasts, implant drop out). The 'gold standard' of periareolar incision, scoring breast tissue, and a circumareolar reduction leads to a greater than 50% complication and revision rate. Although you could go straight to an implant, the size of which is crucial to minimize a lot of post operative complications, I highly recommend at least one round of fat grafting to increase the base diameter of your breasts, making them more amenable to a breast implant. If you choose implants as a first surgery, it should look like this: appropriate sized devices placed through a properly placed inframammary incision and into a subpectoral pocket. No areolar reduction in a first surgery or breast scoring ever. Once skin tension has relaxed upto a few years, areolar reduction can be performed with less risk of re-expansion and thickened scar formation.

Miguel Mota, MD · Answer

Hello and thank you for posting. I believe they are both correct. There is a possibility of you having good results without a peri-areolar lift. But, I would personally prefer having the option of the “lift” in case it is necessary once the implants are in.
The peri-areolar lift is not always used as a lift. Especially not in your case because your areola position is fine, so they do not need a true lift but they are a little bit puffy.  Understand that your slight puffiness might become more apparent with the implants pushing out on the areola. This peri-areolar technique will help keep the tissue in place and avoid any areola deformity. 
Conclusion…. a peri-areolar lift is probably a good idea.

Best of luck, 
Dr. Miguel Mota

Azita Madjidi, MD, MS, FACS · Answer

From the pictures, it seems that your nipples are large and the breast tissue is herniated in them. Also the skin right under the nipple seems very tight. Just putting an implant, will push the nipples further out and implants will ride high if the skin below is not released. It may take one or two surgeries to get it right.

Zoran Potparic, MD · Answer

Based on these photos you do have mild tuberous breast deformity. Correction should include reduction of areola size, expansion of breast base using implants, and correction of areola protrusion. In-person or teleconference consultation with a surgeon experienced in this problem is recommended. Good luck.

Payman Danielpour, MD, FACS · Answer

Thank you for your question
The textbook answer is a breast augmentation.  An implant plus the appropriate pocket work will give you a very nice result +/- periareolar lift to decrease the size of the areola and also make it not as puffy.  Hope that helps!

Steve Laverson, MD, FACS · Answer

Go with your intuition and your own personal preferences.  No procedure is final.  Your areolae do not need lifting but your final breast shape may be improved by areolar and peri-areolar purse string skin tightening.  If you are reluctant for that, defer it until your breasts have expanded to accommodate implants.  Tightening can be added later if you want as an adjustment under local anesthesia.