Follow-up to previous question: What's the difference between tuberous breasts and regular, saggy breasts? (Photos)

Thank you for
continuing to reach out for information and for posting photos. As others have
noted, "tuberous" refers to a specific diagnosis of a deformity,
rather than breasts that are sagging. It is difficult to say with any certainty
whether you have tuberous breasts or not, but it does appear clear that a
breast lift with areolae reduction could reshape your breasts in a way you
would like. If you are happy with the size of your breasts, there is no need to
get breast implants or fat grafting. As for your concerns about scarring from a
breast lift, it is my experience that patients who are disappointed with the
appearance of their breasts are much happier after having mastopexy even though
it involves incisions. The improved shape is simply worth the tradeoff. And
there are excellent treatments available these days to minimize the appearance
of scars. Good luck with your decision.

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision.
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure. Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.

Based upon the submitted photos, it is difficult to say with certainty whether there is a tuberous component. Regardless, you would likely benefit from a lift +/- an augmentation (for greater upper pole fill. Your scarring concerns are legitimate but ultimately you are trading an improved profile for the scar. Patients have to decide if the benefits outweigh the cost.

There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon. Patients should discuss their concerns with their physicians in order to make an educated decision.

Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another.  See the below link on some suggestions on finding the most qualified Plastic Surgeon for a Breast Augmentation.  Always insist on a board certified plastic surgeon.

In my opinion a wise-pattern mastopexy with an implant for the size of the breast you want would be the best option.   (you speak of the breast you want but not illustration is given, I find the breast one woman wants is different for what another may want.)  First, a wise pattern lift is the only option that will increase the length of the shortened skin below the nipple region, typical of a tubular shaped breast.  (Remember that "tubular shaped breast" is a breast shape with multiple features, short distance from nipple to bra line, longer interval from clavicle to the nipple, enlarged and rounded nipple areolar complex that is usually disproportionately larger that the size of the breast.  No all feature need to be found one every single breast called a tubular shaped breast.)Scar will be necessary to decrease the size of the nipple areolar region and lengthen the distance between the nipple and the bra line.  A lift that only consisted of a areolar reduction will not give you the length needed and result in a smaller nipple areolar region that is close to your bra line.  I not sure of any value of fat grafting. Fat grafting only fill in areas of deficits.  You can't use fat grafting to successfully fill out the lower aspect of the breast and stretch the skin to the length you needs.  Just isn't going to happen.  Having  scar to get a better shaped breast is the only option.  

In my opinion, your breasts are ptotic but not tuberous.  I would recommend a breast lift with or without placement of an implant using an anchor scar pattern.  I believe this technique gives an aesthetically pleasing, reliable and long lasting result.  Good luck and be safe.John T. Nguyen, MD, FACS, FICSDouble Board Certified Plastic Surgeon 

Thanks for your question and the photo. As you know a tuberous breast tend to have droop, a high position of the fold and a large dilated areola.   A droopy breast may have the fold in the correct position and will have a normal areola. From your photos  I believe you have tuberous breasts.  Regardless  to give an aesthetic shape the treatment would be a breast lift. Unfortunately scars are the trade off and are something you would have to be comfortable with. Best wishes

There is a definite difference between normal saggy breasts and tuberous breasts.  The breast is a soft tissue structure without any skeleton such as cartilage or bone to give it support and shape.  The breast is held in position and shape by the skin covering it.  If the skin stretches from aging, weight gain and then loss, or pregnancy, you then have too much skin for the internal gland, and then the breast sags.  This is like clothing that is too big for you and hangs more loosely.  This is why a breast lift to correct sagging depends on tailoring and tucking the skin.  Tuberous breasts develop due to a constricting layer of fascia, that restricts breast growth to a very central position behind the areola.  Therefore, the breast is much more narrow, with most of the breast tissue bulging forward behind the areola, spreading the areola and creating a tubular shape.  A tuberous breast is more cylindrical than rounded, and is more narrow than a normal breast.  There are many variations, often with one breast much larger and the other one very underdeveloped.. Correction requires releasing the tight fascia and rearranging/repositioning the breast tissue into a more normal, wider, circular shape.  The areolae are usually reduced and the breast tissue no longer bulges the areolae forward.  Most of the time, especially if one breast is very small, implants are used to add some fullness.  Although this might sound complex, this approach is standard and creates a very nice shape that can be life-changing for young women.

Dear Ali,Thank you for your question and pics.It does appear that you have ample breast tissue to create nice cleavage and perky breasts. There is a technique that allows to reshape and provide maximum lift without implants or the need of a vertical incision. The incisions will be hidden around the areola and in the inframammary fold. I welcome you to visit my gallery to view some examples. You do not need implants to create a fuller more youthful appearance. I hope this helps.Best wishes and kind regards,Gary Horndeski M.D.

Thanks for your question and pictures. I agree with my colleagues, you do not have tuberous breast deformity. The criteria are constricted base, herniation of tissue through the areola, and wide areola. Ptotic breasts have a normal or round breast shape with the nipple and or breast tissue lower than the fold. There is no way I can consistantly improve breasts like yours without using traditional breast lift scars. Hope that helps!

Tuberous breasts is a deformity where as saggy breasts or breast ptosis is an extremely common result of stretching of the skin  as a result of weight gain and loss, pregnancy, gravity, time, and genetics.Tuberous breasts have a extremely constricted base with an enlarged areola.  There is a herniation of the breast tissue into the areola presumably as a result of the tissue not having enough room at the breast base so it pushes through into the areola.In my opinion, you have breast ptosis with enlarged areola, not tuberous breasts.  I would recommend a circumareolar mastopexy.  This procedure hides the scar In the new areolar border. If you want to be bigger then consider implant augmentation at the same time or at a later date.  Many plastic surgeons realize the difficulty in controlling the result when doing them together.  The mastopexy tightens skin while the implant augmentation expands the skin both increasing pressure on the repair.  Placing the areola in a proper and symmetrical position becomes more challenging.  Only the most experienced plastic surgeons should do these procedures at the same time.Fat grafting could be done as a follow up procedure to fine tune the result or increase the size but these techniques are much less commonly done than mastopexy and implant augmentation.All my best.