Are Saline or Silicone Implants Better for Tubular Breasts?

Question

At 20 years old, I have tubular breasts set far apart and have been looking into mastoplexy surgery. I understand that there are two options: saline or silicone implants. I am aware that the FDA has not approved silicone implants for patients under 22, but I am unsure if having tubular breasts allows for them, considering it's technically a deformity and would be considered a reconstructive procedure. I fear that although saline implants may temporarily correct the problem, I won't be satisfied.

Brent Moelleken, MD · Answer

The treatment of tubular breasts in our practice usually consists of

	- not selecting a size larger than the base diameter of the breasts (or they bulge out)

	- using relaxing incisions (these only help to a degree)

	- using higher profile implants (that maximize the volume given the small base diameter)

	- performing a periareolar lift for the baggy areolar area.

	Patients must be realistic about their outcomes.  The choice of which implant is a personal one based on weighting the risks, necessity of getting MRI studies after silicone gel implants, etc.

Paul Vitenas, Jr., MD · Answer

In general I prefer silicone implants for all breast work as I think they feel more natural and are better implants. For tubular breast treatment you are having reconstructive work, therefore, you are eligible for silicone implants. The comments about the severity of the deformity are very germane so without a picture it is difficult to be more specific. I suggest you find a surgeon you are comfortable with and let them guide you.

Michael J. Weinberg, MD · Answer

The treatment of the tubular breast is complicated. Implants are only one part. Saline and gel implants both work well. Gel implants generally feel and look more natural - so in general I prefer them. Specifically for the tuberous breast the inferior pole can be quite thin after it's treated ( scorred) so gel is definitely better.

Richard Baxter, MD · Answer

Tubular breasts come in several versions and so there is no single best answer. What they all have in common is tightness of the skin envelope over the lower part of the breast, and so using an expander saline implant (Mentor Spectrum) can be very helpful for that. This is a saline implant that is connected to what is called a "fill port" which you would see as a bump under the skin below the breast. Every few weeks some more saline is injected into it so that the skin is slowly stretched. This way you also get to see different sizes during the exp-ansion, and within certain limits you can decide what you like. The fill port is removed under a simple local anesthesia procedure about 3 months after implant placement. Additional procedures may be required for tubular breast so you really need to see a plastic surgeon who does a lot of them.

Otto Joseph Placik, MD · Answer

Correction of tubular breast typically involves addressing 3 aspects of the "deformity: Small size Large areolae Narrow base diameter Therefore surgery respectively consists of Implant augmentation Circumareolar reduction Radial relaxing incisions. 

	 

	Regarding implants, silicone are only available if you are over the age of 22.  IF you wish to have surgery sooner than your 22nd birthday, I would consider saline.

Beverly Friedlander, MD · Answer

There are many factors that lead to an aethetically pleasing result. The use of Silicone vrs Saline is not one of them as both can create excellent results. The key to a good result is identifying the problems and correcting them. Not all tuberous breasts are the same. Some require an uplift and implant , some require only an implant. All will require some type of expansion of the lower part of the breast to create fullness here because natural breast tissue is absent in the tuberous breast. There are many different responses that have been posted to your question, but the best sugical approach really depends on what your breasts look like. Please discuss this thouroughly with your plastic surgeon.

Scott W. Mosser, MD · Answer

For a procedure like this I&rsquo;d recommend strongly that you consult with a board certified plastic surgeon with quite a bit of experience in augmentation and cases of tubular breasts. You&rsquo;ll be able to do a physical examine and determine what specifically your best options may be.
	Generally, tubular breasts require a surgical release of the lower breast. As a result, there is often not a lot of breast tissue covering the implants. Since saline implants have much more visible rippling when there is thin tissue coverage, I recommend silicone breast implants for most tubular breast augmentation patients. Again, consulting with your surgeon is important as a first step&hellip; then you can map out your game plan.

Bernard A. Shuster, MD, FACS · Answer

Dear Snikki,

	The question of whether to select a silicone or saline implants comes up dailey. Either implant can give you a beautiful result. Having tuberous breasts should not particularly influence your decision. Rather I suggest patients consider the advantages of each and weigh it against their comfort level with the complication rates for each type.

	Best of luck

Tom J. Pousti, MD · Answer

Tubular or constricted breasts can be improved with or without breast implants and may require additional incisions to improve the shape of the breasts. It all depends on the severity and complexity of your case and what look you would like to achieve. I recommend consulting with a board certifed plastic surgeon to discuss the best and safest possible options for you. During your examination, your surgeon will let you know whether you are a good candidate for saline or silicone gel depending on your body type. Silicone gel is the more naturally feeling of the two and is recommended for patients who have very little breast tissue to begin with and a low percentage of body fat. Saline implants can provide a fuller look but has a higher risk of rippling and palpation of the implants if you do not have enough coverage. Providing photos of what look you would like to achieve will be very helpful to your surgeon. Communication is very important between you and your surgeon. Good luck and take care.

Steven Schuster, MD, FACS · Answer

This is a case of its not the wand but the magician.  Both implants work equally well although I prefer silicone in general.  The important point here is that the operation is done right, very often by using a bi planar approach and scoring the undersurface of the breast.  The key is not to do a vertical lift as this will increase the lower pole tightness.  You want to expand the lower pole as much as possible.  I have just started using alloderm to expand the lower pole allowing me to do more radial release.  

	Again, the key here is the operation and not the implant.  Good luck, Dr. Schuster in Boca Raton

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