Breast Augmentation - HELP! I have seen three different plastic surgeons and they have all provided a different opinion (Photo)

I have seen three surgeons and each have given a different suggestion - very confusing! I am willing to travel anywhere in Australia. I understand it isn't a straight forward as I am tuberous and have a large chest space.. Would love a consensus! 1. Round + Smooth: DR said I need round for fullness in the upper chest. Anatomical would emphasis flat chest area. 2. Round + Textured: DR said textured required so implants don't drop, and would need to wear a strap in recovery to push out the bottom

Doctor Answers 6

HELP - breast augmentation

Hi,It can be confusing but there are pros and cons to all of the issues you raise.In your mind will be a picture of the result you are after, and getting this message across to the surgeon is the key to success.  From there a surgeon will likely advice on incision, implant shape, texture, and location to achieve the result you are afterDifferent surgeons will have different approaches though as chefs will have different recipes to achieve what they regard as the best result - that will then come down to personal taste, so you need to see before and afters to assess if the result the doctor achieves is one you like.From there it should become easier and clearer which path is the right one for youJeremy Hunt

Sydney Plastic Surgeon
5.0 out of 5 stars 118 reviews

I don't think you have tuberous breasts at all!

In my own opinion, based on the images you have provided, I don't think you have tuberous breasts.  There are some specific features of your breasts that we can point out, just as there are in most breasts, and these must be noted and taken into consideration to produce the best results, again as is the case in most breast augmentation procedures if we are to get the best results.  I personally think the term "tuberous" is thrown around way too much in the plastic surgery circles.  This may be only an academic issue to some at this point, but I still think it's worth discussing a bit.  First, a brief anecdote to illustrate what I’m saying:  When my youngest daughter was about 4 or 5 and beginning school with other children, she began to really take note that not everyone around her spoke English.  She grew up in Southern California, and there are lots of Hispanic people here who speak Spanish.  I speak Spanish, and she would hear me talking to people in Spanish sometimes.  Our housekeeper also spoke to her in Spanish every time she saw her.  Thus, her first and predominant exposure to any foreign language other than English was Spanish.  One night we were having dinner at a restaurant, and a family in the booth behind us was speaking in their native tongue.  My daughter was amused, and quietly said to us in a very authoritative commentary with the most serious and educated look on her face:  "They're speaking Spanish, you know."  I looked over there, only to find that it was a Chinese family bantering away in Mandarin!  Everything that wasn't English to her was Spanish!  I've always thought that was cute and funny!  And it illustrates the point here:  I think the same happens with breasts - anything that isn't a "perfectly shaped breast" and has some feature in common with that condition becomes "tuberous," or "tubular," or some other similar term to the uninitiated.   From that, very often comes a treatment plan directed at the so-called "tuberous" deformity.  In reality, tuberous breast (so named for its similarity in shape to a "tuber"), or sometimes called "tubular," for similar reasons by some surgeons, has a number of very specific features that make it so.  The deformity arises from an abnormality in the compliance of the skin and connective tissues overlying the developing breasts as the glandular breast tissue begins to enlarge at puberty.  The skin and connective tissues don’t stretch and comply with the demands of the growing gland, and certain specific features result.  Among those are typically a high inframammary fold, a tight, or “constricted” lower breast contour, herniation, or protrusion of the breast tissue through the nipple/areolar complex as this becomes the “weak link in the chain” for the expanding breast to grow into, and an elongated, disproportionately narrowly based, cylindrical, or tubular, shape to the breasts.  That is true tuberous breast.  While there may be the occurrence of one or more of these features with an otherwise normal breast, I don’t think that makes that breast tuberous.   I think this fine point is important to note, not only from the standpoint of academic attention to detail and accuracy, but because understanding the finest details of each individual person’s anatomy is of paramount importance, in my opinion, to formulating recommendations to meet their goals.  For instance, while you may have a high fold or narrow base on one breast, if you have normal compliance of the tissues otherwise, and thus, you do not have true tuberous breast, we should take that into account in our surgical planning.  Such is the case with your breasts as I see it, based on the images you have provided.  You do appear to have narrow based breasts with generous space in the middle of your chest between them, although the proportions of the overall breast mounds are more or less normal.  You simply have small breasts for the width of your chest wall.  There is also some asymmetry with one breast slightly larger and lower than the other, with mild ptosis, or drooping, of the left, slightly divergent and asymmetrically placed nipples, relatively short lower pole arc length (the distance between the nipple and your fold), and to me, otherwise normally shaped, albeit small, breasts with volume distribution within the range of normal throughout the breast mounds.  You may have isolated features that are found in tuberous breasts, but I don’t believe you really have tuberous breasts.  In cases like this, where optimal absolute shape and volume of each individual breast, along with symmetry, or optimal relative shape, volume, and position of the breasts and nipples together are the goals, we first have to acknowledge that we may have to do slightly different things to the two breasts, as they are slightly different to begin with, if we want to wind up at the same place in the end.  After that, I think the next most important thing to determine is how you want that all to look in general.  This is largely dependent upon YOU and YOUR preferences.  As you have discovered, there are lots of surgeons out there with lots of different opinions, but the one that will win the day is the one with the opinion that most closely achieves YOUR goal.  Thus, you will have to decide in general how you want your breasts to look, in order to help your surgeon guide you to the right operation.  Do you want fuller, rounder breasts, especially on the top aspect?  Round implants may be the way to go in that case.  Or, do you want a softer, more subtly sloping upper pole of the breast?  Shaped implants may do this better for you.  Do you want wider based breasts that fill in your cleavage area and create some lateral, or side, projection of the breasts, or do you want a “sleeker” look with the breasts confined more to the dimensions of your chest wall?  If you want better nipple position and symmetry, you will likely need some form of lift, such as a periareolar lift, on one, if not both breasts to achieve this.  The best ways to communicate these, and other, preferences like size are with sizing in your surgeon’s office using specially designed breast sizers, “wish images,” or pictures displaying specific features of breasts that you like (or don’t like), and lastly some digital imaging programs have some use, but I have personally not found those to be as useful as other methods.  These things, coupled with careful analysis, including detailed measurements of your chest and breasts, and comprehension of the details of your anatomy by your surgeon, will put you on the right path toward planning the operation that will make YOU the happiest.  This might include a number of the options that you have heard about here as well as in your consultations:  shaped implants, textured round implants, high profile or moderate profile, with or without a specific type of lift, and so on.  It is also worth noting that sometimes techniques are close enough that two different options may wind up producing very similar results in the same person.  This is why I cannot emphasize enough that the planning begins, and hinges almost entirely on, your very specific goals and a very careful and accurate analysis of the preoperative breasts.  This starts with the selection of the right surgeon and an understanding on your part of exactly what you want.  Then it becomes simply a matter of communication between surgeon and patient until both are satisfied that each understands the other - surgeon understands accurately what patient wants, and patient understands sufficiently what surgeon is recommending and what those recommendations can reasonably be expected to produce in said surgeon’s hands.  If this mutual understanding is not there yet, I strongly advise you to persist in asking questions of your surgeon, communicating your own expectations and goals to your surgeon using every means possible, and working at this until it is.  If you don’t feel as though you are getting anywhere with one surgeon, abandon that relationship and find another.  This is a detail oriented undertaking, depending of course upon how detail oriented you are as a person, and the preoperative planning will set in motion the events that will ultimately culminate in the result you will achieve.  I know that you have already had many consultations, all with differing opinions, and you probably came here looking for one of us to “break the tie.”  Unfortunately, that won’t be possible, as this is something that can only be done during in depth personal consultation, including physical exam and measurements as I have described above.  Hopefully, though, I’ve contributed some ideas and concepts to help you better navigate that consultation process with the surgeons in your area, so that you can get a deeper understanding of the options that are before you.  In the end, if they put forth the right effort in vetting their surgeon and his or her plan, I think most people sort of “know” when they have found the right match.  This is not to say that any one of us is perfect or has a crystal ball to accurately predict the outcome of anything we do, but we have a “sixth sense” when something seems right.  You will maximize your chances for success with this if you stick to only board certified plastic surgeons who have lots of experience with all different types of breast surgery.  Again, not that any of us is perfect, but those with proper board certification and credentials are going to be the most likely to expertly and reliably produce the results that you are looking for.  Best of luck!

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 87 reviews

The right size for you

It is very difficult to determine the best lift you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implants

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Implant choice

Thanks for sharing your storyDefinitely don't get smooth round implants. I don't think there is an ambiguity there.
I think tear drop textured implants in a dual plane pocket would be the best for you.
I hope this doesn't confuse you even more.

Pouria Moradi, MBBS, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 89 reviews


Hi.  Whilst I agree you are not a straight forward case, I don't think you are necessarily as difficult as you have been told. I think your right breast is normal albeit with a laterally placed nipple.  The real issue is the left breast which is definitely a tuberous breast but mild in in its severity.  As the right breast is relatively straightforward I will concentrate on the left.  The key thing in my opinion is the plane of augment - the release of the lower pole is paramount and best achieved with either a subglandular approach or a dual plane 3 submuscular.  The type of implant will depend on the type of look that you want to achieve and the size you want to go. Either way I would choose textured and round for a less natural look, teardrop for a more natural look. I would be happy to give you a 4th opinion if required.RegardsDamien

Different opinions for breast surgery for constricted/tuberous breast…

Thank you for the question. It is extremely common to receive different opinions from different plastic surgeons about the best way to treat a specific “problem”. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices. It is quite amazing how adamant each plastic surgeon can be about the superiority of his/her recommendations…

Although these different opinions can be confusing and a source of anxiety for patients, it is good for patients to understand the different options available. Ultimately, it will be up to each patient to do their due diligence and select their plastic surgeon carefully. Part of this selection process will involve the patients becoming comfortable with the plastic surgeon's experience level and abilities to achieve their goals as safely and complication free as possible. If I were you, I would ask to see as many examples as possible of similar patients who your plastic surgeons have helped.

Generally, correction of tuberous breast anomalies involves breast augmentation with areola reduction/mastopexy procedure. The distance from the inframammary fold is increased (to create a more rounded out appearance). Proper implant positioning improves the distance (cleavage) between the breasts. The areola reduction helps to treat the pointed and "puffy" appearance of the areola.

Generally, patients who start out with constricted/tuberous breasts may need to be more patient when it comes to viewing their final outcomes (after breast augmentation surgery) compared to patients who do not start out with these anatomic findings.  Because the breast implants take time to "settle" into the relatively tight tissues of the lower breast poles, it may take several months (six months or even longer) before the final outcome of the procedure is achieved. In other words, patients undergoing this type of surgery should be aware of the need for patience and time before the lower breast poles "round out".  Also, generally speaking, as the breast implants "settle" into their positions, the nipple/areola complexes seem higher on each breast mound ("perkier").

In my practice, I tend to use  smooth round silicone gel breast implants for patients undergoing corrective surgery for tuberous/constricted breasts.   Again, however, I think that careful selection of plastic surgeon will ultimately be much more important than the shape or surface characteristics of the breast implants utilized.
 You may find the attached link/video helpful to you as you learn more. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,486 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.