I been consulting a few surgeons regarding a breast augmentation, all of them explained me about me having TBD (Photo)

one said that could fit any implant without no problem, I settle for 600cc, the 2nd told me that he could lower my breast crease, I settle for 450cc shape silicone, the 3rd told me the procedure that the 2nd doctor described I may have the problem with double curved breast, he suggested expanding the breast before the implants go in of a few weeks. So do think I can lower my crease and have a good results? attached pictures and I measure between crease and aureole there're 3 centimeters.

Doctor Answers 13

Augmentation and Tubular Breast Deformity?

It can be confusing and frustrating to patients when they get three different answer from three different surgeons on how to deal with a challenging breast problem. To some extent this reflects the fact that there is not a clear consensus amongst surgeons on the optimal treatment for the problem, but that doesn't help you too much with deciding on how to proceed. So I will try to provide you with some background information and then discuss the pros and cons of the various treatment options.


I would agree that you have a variation of a tubular breast deformity. There is a wide range of breast shapes that would fall into this category, but in general the term TBD implies a smaller diameter base of the breast, a constricted or underdeveloped lower pole (which means short areola to crease distance), and a protruding or misshaped nipple/areolar complex. Usually there is also a wide space between the breasts. Not all patients have all components of the problem. In your case, you do not have an excessively protruding nipple/areola, but you do have a tight, elevated inframammary fold or crease, and your breasts are located quite far lateral on your chest wall. All of these issues have implications for how one would approach your situation.


A breast implant is almost always a component of treating the problem, both to enlarge your breast but even more importantly, improve your breast shape. In particular this means expanding the lower pole of the breast so that the distance between the areola and fold is increased, there is more lower pole fullness, and the implant ends up centered behind the nipple so your nipple is pointing straight ahead. To accomplish this many surgeons talk about "scoring" the tight contracted breast tissues from the inside, and then using an implant (or an expander - more on that later) to accomplish this expansion. Another component of increasing the distance from the areola to the fold is to lower the fold or crease. Many surgeons advise against this because it can result in the creation of something called a double bubble. I would strongly disagree, and in most situations it can be done with a low risk of creating a double bubble if the surgeon has the technical knowledge and skills of how to do this. There are situations however where the risk of a double bubble is increased, and I would say that you would fall into that category because you have a high a very tight inframammary fold which will predispose you to the DB problem. So in your case I would be conservative in lowering your fold.


Another way to increase the distance between your areola and breast crease is to do a breast lift, but this introduces extra scars to your breast and can be problematic if at the same time one is trying to put in a breast implant because it puts excessive tension on the incisions which results in poor scars. Also many patients simply do not really need a breast lift. If one does need a lift then this is a good solution for the problem of increasing the distance from areola to fold but it doesn't apply in many situations. For patients that have a distinctly protruding areola, doing a donut (also known as Benelli)  type of breast lift is the accepted way of correcting the nipple deformity. In your situation your areola does not look to be excessively protruding or deformed, so I likely would not recommend doing this, at least initially.


I think that simply blasting away at the problem by putting in a larger implant (600cc) would not be a good choice. This would just subject you to other types of problems such as palpable/visible implant, visible rippling, and implant malposition, particular lateral, because your breast are located so far lateral on your chest wall. This would be especially true with a smooth surface implant. I also think that in most cases it not necessary to use a breast expander. The implant will act as an expander and doing a staged expander and then implant just adds an unnecessary operation and significant additional expense.


So in balance, I would likely come down in favor of your second option. That would be some conservative lowering of your fold or crease, scoring or release of the tight fascial bands in the lower pole and placement of  a textured shaped implant of at least 450 cc. Why the shaped implant? Because most of the volume is in the lower portion of the implant which is where you need it and where it will do the most to expand the lower pole of your breast. Also the textured surface implants are more predictable because they adhere to your tissues and will be less likely to migrate towards your armpit over time. I would reserve the option of doing a donut or Benelli type of lift at a later date if you felt that your nipple was still  too protruding or you needed just a little extra elevation of your nipple position.

Tuberous breasts

The most important decision is the surgeon you pick, who will then help you make the rest of the decisions.  Pick someone who can show you several tuberous breast results and review how those breast compare to yours.  Below is a link with information and photos of tuberous breasts. Best wishes. 

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 32 reviews

Tuberous breasts

are often challenging when considering augmentation.  Implants will not correct the anatomic problems of the narrow base and generous areola.  In my opinion, go for the size you want... after all, why are you considering this in the first place?  Realize you will have some crease on your inferior pole that does stretch out with time but may not completely.  My patients are asked to focus on the upper poles being full and level since that is what the world sees.  Only privileged will see your lower poles as swimsuits cover this too.  If you want the best appearing breasts undressed, then you have to consider going smaller and you will still have issues with the crease but hopefully not as much.  As for shaped or round implants, they both will stretch out the bottoms so you can still choose that you want.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Breast Augmentation for "Tuberous Breasts"

With all the answers you have to your question, I am sure that you are confused.  By definition, you have what is known as Type 2 Tuberous breasts according to the Von Heimburg classification.  While you do appear to have this it is only minor and what can be seen from your photos is mostly a small breast.  What needs to be done to get a good result really depends upon your goals.  If you want a large implant, then you will likely not need anything else to be done and if you chose an smaller implant, you may need a slight lowering of the pole and perhaps an periareolar lift but remember that a lift of any kind will invovle scars arlund your areola at a minimum.  

I would recommend that you get measured and sized with sizers in a bra and consider a shaped implant like the Sientra gummy bear to give you want you want.  Once you decide that, then your surgeon can guide you on the technical details of what needs to be done to get a good result.

I hope that helps.

Best regards. 

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 56 reviews

Tuberous Breast options

Tuberous breasts can be challenging, and as you have experienced, many surgeons have their preferred surgical method. I would use a single stage approach releasing the bands of the lower pole at the time of the augmentation. The size and shape of implants depends on your goals and the measurements of your breasts. I always make sure my patients with tuberous breasts understand that it takes longer for the implants to settle into a more natural position/shape than with non-constricted breasts, so patience is a must. Good luck!

Dustin L. Reid, MD
Austin Plastic Surgeon
5.0 out of 5 stars 78 reviews

Tuberous breast

Hello and thank you for your question. You do appear to have tuberous breasts.  I perform this surgery as a single stage with an implant and release of the lower pole constriction bands.  The size, profile, and shape of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 77 reviews

Tubular and Ptotic Breasts

Hello,

As I assume you realized, that you can't have any implant you want. In fact people like you are most limited in size of implant, mostly due to the nature of the inframammary fold and breast tissue. You can get a nice improvement in shape and size if you let an ABPS certified/ASAPS member surgeon expert in all aspects of breast surgery, not just implants, plan and perform your surgery. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Tuberous breast deformity

Thank you for your photographs and question.  I recommendation would be to avoid lowering of the inframammary crease due to the risks involved but instead to have either a periareolar and areolar reduction and uplift or a vertical lollipop uplift combined with placement of conservatively sized implants.  The implants that were suggested to you are far from conservative in my opinion although I do not have your height and weight dimensions.  I would start with a smaller implant and if necessary after 12 to 18 months consider the option of a larger implant replacement. Seek other opinions before making a commitment.  Best wishes for a good result.


Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California


Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Tuberous breasts

You do have tuberous breasts and my approach is a single stage surgery. I do not beleive in expansion and also do not believe in extremely large implants. I generally place a moderate size implant, open the pocket from inside, lower the fold and perform a peri-areolar lift in order to improve the position and shape of the nipple. This has been very successful and gratifying. These are challenging cases but can be well executed with basic knowledge and an artistic eye. Best wishes. See photo.

Sepehr Egrari, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 48 reviews

Breast augmentation with TBD?

Thank you for your question and photos. You do have TBD with a contracted lower pole. This means that the distance between the areola and your natural fold is short. Any augmentation procedure needs to provide the correct volume, elongate the lower pole distance, and elevate/shape the areola. Because of your natural shape, you will always be at higher risk for so-called 'double-bubble' deformity of the lower breast. This risk can be minimized with careful implant selection and placement. 600 cc seems like a large volume to me, for someone of your stated height/weight. If you are still confused or uncertain, have another consult with a local plastic surgeon to discuss your concerns.

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 15 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.