What grade of tuberous breast am I? (Photos)

Question

I'm quite confident I have tuberous breasts but do not know what grade this would be. I am wondering because I am looking at having surgery to correct it and would like to know the likelihood of medicare giving me a rebate. Also, my private health insurance covers "non-cosmetic plastic surgery" - does the amount covered by my insurance depend on the severity of the tuberous breast? How much would likely be covered by insurance?

Robert M. Tornambe, MD · Answer

mcrose1.   Your deformity is significant, and I would recommend a 2 stage reconstruction. The first stage would be placement of tissue expanders, as your skin is very tight. Once inflated, they can be exchanged for silicone implants and further refinement can also be done. I am not sure how your health system works in Australia, but it should be covered because your condition should be considered a "birth defect". Seek out a board certified plastic surgeon with lots of experience with breast surgery because your case is significant, but correctable! Good luck!

Larry S. Nichter, MD, MS, FACS · Answer

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.

Steve Merten, FRACS - Account Suspended · Answer

Hi Mcrose,

You have Grade 4 tuberous/constricted breast deformity, and will need a combined augmentation mastopexy. You will meet the criteria for Medicare cover, so your health insurance should cover your hospital costs and implant costs, and you will get rebates for the doctors fees. These are complicated surgeries, and you should see a local surgeon will expertise and interest in treating this condition. Regards, Dr Steve Merten, Sydney

Martin Jugenburg, MD · Answer

HI there, Thank you for your question. Yes, you do have tuberous breasts. You will want to have surgery with a board certified plastic surgeon to specializes in breast reconstruction. This operation should be covered. Best, realdrsix

Joel M. Stewart, Jr., MD · Answer

You have a severe bilateral tuberous breast deformity. While some cases can be treated with a single stage surgery involving implants and possible nipple repositioning and reduction, yours would most likely need a 2 stage procedure.

In my opinion, tissue expansion and then augmentation to follow would yield the best results.

Insurances will sometimes pay for these procedures as this is reconstructive.

Best of luck.

Damien Grinsell MBBS, FRACS (Plast) · Answer

Hi. You definitely do have a bilateral tuberous breast deformity and it is severe. You would attract ameficare item number and would be covered with the policy with private health insurance. You are a tough case. Good luck.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures. I think your breast photos all of the characteristics seen with tuberous (constricted) breasts. For example, the distance from the areola to inframammary folds seems to be tight and relatively short. Your inframammary folds seem to be widely spaced from the midline of your chest. The areola do demonstrate some features associated with tubular breast such as an increased width and “puffiness”.

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.In your case, if the appearance/shape/size of the breasts are a concern, you may be an excellent candidate for corrective surgery. In my practice, I would certainly recommend the use of silicone gel breast implants placed in the sub muscular (dual plane) position.  Sometimes, based on careful physical examination and careful communication of goals, I find a two-staged approach helps minimize  risks of complications and improve final aesthetic outcomes.

When you are ready, please make sure you consult with well experienced board-certified plastic surgeons who have significant (demonstrable) experience with this type of surgery. There are a lot of factors to consider when making recommendations; for example your life circumstances ( planned pregnancies, psychosocial situation…) and tolerance for scars are factors that should be taken into consideration by you and your plastic surgeon. Patient should be aware that the final result will take months to see and that they will need to be patient and that revisionary surgery is more likely than in patients who do not present with tuberous (constricted) breasts.

The good news:  in our practice, some of our happiest patients have been patients who have started out with constricted/tuberous breasts.I hope this, and the attached link (dedicated to corrective surgery for patients with tuberous/constricted breasts) helps.  Best wishes.

Pouria Moradi, MBBS, FRACS · Answer

Thanks for sharing your images and your storyYes you definitely have tuberous breast deformity and your insurer and medicare will cover some of the costs.In Australia, the rules are pretty simple:-see a Plastic Surgeon: he/she will examine you and take photos and send them to medicare-if medicare approves them as tuberous breasts (which they definitely will), then you insurer (as long as you have the correct level of coverage...MBS code 45559) will cover the cost of the hospital, operating theatre, implants and around $1000 of the surgeon's and anaesthetist's fees-that leaves your out of pocket fees for your surgeon which varies greatly  I hope this helps and good luck

Timothy A. Janiga, MD, FACS · Answer

You do have severe tuberous breasts.  This can be corrected in one or two stages. A two stage approach would probably give you the nicest result but does require more surgery.  It also depends on whether you can get coverage for your operation.  In the U.S. we have difficulty getting insurance companies to cover this operation and so many women end-up having a one-stage reconstruction due to cost constraints.  Meet with a board-certified plastic surgeon in your area and they will be able to guide you further.  Take care!Timothy A. Janiga MD, FACS

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