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

A few doctors who replied said it doesn't look like I have tuberous breasts. I was wondering what the difference between tuberous breasts and regular saggy breasts are? And if I don't have tuberous breasts, why does the underside look constricted and doesn't have as much skin? Also, all the doctors said a mastopexy would be a good choice for me. I was wondering if there's any other way to get a lift without having scars(or very minimal scarring).

Do I have enough breast tissue already to have the look I was going for or would I need a fat graft as well?

Doctor Answers 31

Saggy or Tuberous Breasts?

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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.


West Palm Beach Plastic Surgeon
5.0 out of 5 stars 32 reviews

Tuberous vs saggy breasts, what's the difference?

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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.

Tuberous Breasts vs. Saggy Breasts

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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.

Rocco C. Piazza, MD
Austin Plastic Surgeon
5.0 out of 5 stars 8 reviews

Maximum breast lift with no vertical scar

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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.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Tuberous vs. Ptotic Breasts

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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!

Surgery

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Hello dear, thanks for your question and provided information as well.. The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift. I recommend you to have a breast lift with silicone implants. You have saggy breasts with severe ptosis, also I recommend you to reduce your areola re-locate it up, you will have beautiful results on your breasts after surgery. 

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.5 out of 5 stars 442 reviews

Mastopexy

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You have ptosis (sagging) of your breast tissue and nipple below the fold of your breasts. You would have a very nice result from a mastopexy as this would lift and reshape your breasts in a perky, more proportionate way. Unfortunately, we cannot avoid scars in this situation and you would require the standard "anchor" type scar in my opinion. Still, satisfaction is very high and once your scars fade, you will be happy you did it. Good luck and thanks for sharing!

Joel Patrick Maier, MD
Cincinnati Plastic Surgeon
5.0 out of 5 stars 33 reviews

Tuberous or not?

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The classic components of a tuberous breast deformity are a narrow base, widened areolas, and protrusion of breast tissue through the areola.  Then there are variations where one component or another is not present or may not be fully expressed or severe.  So, while it is not possible to offer opinions with 100% certainty based on photos and no physical exam, I would have to say that you do have a variant of the tuberous breast deformity.  The base is somewhat narrowed and the areolas are very wide.  I do not see any protrusion of breast tissue through the areola.  Regarding treatment, you are a candidate for mastopexy (breast lift) alone if you are satisfied with your breast SIZE and only want to reduce the sagging.  You would also be a candidate for combination mastopexy and augmentation if you want to reduce sagging and increase size.  Either way, a mastopexy would be required to obtain a satisfactory result, and you will just have to come to grips with the fact that you will have scars.  Best of luck!

Tuberous Breasts vs Sagging Breasts

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Thank you for your question. You do not seem to have a tuberous breast deformity which would occur during development and be noticeable at a young age.  You seem to simply have aging skin, and loss of glandular tissue. My recommendation would be to have a lift and then possibly an augmentation to give you some upper pole fullness, making the breasts look more perky and youthful.  Unfortunately, in your case you would have to have a vertical lift with scars around the areola and down the center of the breast with a slight hook or anchor underneath the breasts.  Best wishes.

Breasts not tuberous

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Your breasts do not looks tuberous. Tuberous breasts have variations of several components, including a very narrow base and herniated tissue through the areola. You do not have those.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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.