I am looking for surgeons whom do a lot of and/or specialize in tubular breast augmentation!! Suggestions?! (photo)

I do not believe that you need a mastopexy.  An excellent outcome can be achieve with breast augmentation alone, without the additional scars of the lift.The
first thing you should do is check the ASPS website for a list of doctors in
your area. Then look at online reviews. Check the surgeon's
website. Look at their results. Ask around to see if you have any
personal references, these can be very helpful. Once you have screened
the doctor, meet with them. If they are professional and sincere, educated and
experienced, if they listen to your concerns and develop a plan which fits with
your goals, you have found a good match.The most sophisticated approach to
breast augmentation is through the armpit with a surgical camera (transaxillary
endoscopic). Using this modern approach the space can be crafted under direct
vision, with virtually no bleeding and no postoperative bruising. Most
importantly, the shape of the breast is meticulously created. The other, older
methods of insertion are technologically less advanced. Both silicone and
saline implants can be placed through the armpit by a surgeon with skill and
experience using this approach. The incision in the crease is the oldest method
of placing the implants and puts a scar directly on the breast.



A round implant would be a better
choice because they move more like breasts. The anatomic implants have a
textured surface which makes them feel very unnatural. In addition, there is no
benefit to anatomical. There is an X-Ray study that shows the implants from the
side at 6 months. Standing, the round and the antomical implants have the same
profile. When you lie down however, the anatomical implants do not change,
which is unnatural. A round implant will change when you lie down, like a natural
breast would.



HP implants, which are a more modern
shape than moderate profile implants, fit most women better. They have a more
appropriate base diameter and can be made to look very natural or very
augmented, depending on where in the range the implants are filled to achieve a
particular volume. High profile implants are the first choice in my opinion. I
rarely find an indication to use moderate or moderate plus implants. The
subtlety in the final outcome is not achieved by which profile implant is used,
it is determined by the skill in the creation of the pocket, the choice of
volume, and where in the range the implant is filled.



There
are many advantages to sub muscular dual plane placement and very many
disadvantages to sub glandular placement. I would see no indication to do
anything but sub muscular dual plane. Subglandular silicone implant
placement is the historical approach to this surgery, and was widely used in
the 1960's. The implant edges are more visible, the risk of rippling is
higher, the implant is in contact with the non-sterile breast tissue so the
risk of infection and capsular contracture is higher. The interface
between the breast tissue and the muscle is blurred so the implant interferes
with mammography more than sub muscular placement. The blood supply
surrounding the implant is worse so the risk of capsular contracture is higher.
The support for the implant is less so there is more long term shape
abnormalities and sagging. The look of a sub glandular implant is much
less appealing than a sub muscular implant. The placement of sub
glandular implants makes any subsequent revision surgeries more complicated and
less successful. There are no advantages to sub glandular implant
placement.



The choice between saline and silicone
is one that requires a complex discussion of all of the advantages and
disadvantages of both implants. The issues to be considered are safety,
density, mobility, rippling, rupture rate, consequences of rupture, detection
of rupture, need for follow-up care, cost of follow-up, appearance, feel,
sensation of heaviness, radio-density, mammograms, and costs, among other
things. There are advantages and disadvantages of both products. The decision
will ultimately be up to you based on what is appropriate for your particular
situation. Beautiful results can be obtained with either implant.



The best way to determine the size that
fits your personal perception of the perfect breast is to try on sizers. This
way you can see how they fit on you, how they add to your current volume, and
whether they fit your frame. Although the surgeon can guide you, only you will
be able to tell what is the right size. Try on sizers. Measuring a diameter and
then telling the patient what volume they can have (in high, moderate or
moderate plus implants) in my mind is backwards. The patients should be allowed
to choose the volume. Then the surgeon carefully considers the base diameter,
projection, profile, manufacturer, and fill material that will achieve the
patients goals of size as well as qualitative look (natural, intermediate, or
bold upper pole fullness or projection), all the while taking into consideration
the patient's anatomic features that will affect the outcome. The experience of
the surgeon and the degree to which they explain the options to you is of
utmost importance. The subtlety in the final outcome is not achieved by which
profile implant is used, it is determined by the skill in the creation of the
pocket, the choice of implant. Don't let the doctor tell you what would look
good on you. They cannot tell what you perceive to be the best size. There is
no maximum. That is up to you.

Based on your photograph, combining a breast lift (mastopexy) with augmentation would likely be beneficial in your case. Implants would give the breasts more volume and improve contour by improving upper pole fullness and enhancing roundness and projection. Lifting the nipples to a higher position and reducing the size of your arealoae, most likely with a vertical breast lift, would also be beneficial. The vertical lift would involve a circular incision around the areolae and vertical incision below. Of course, determining the best option for you requires a thorough consultation. Thanks for your question.

HiYou do have some tubular shape but you have been spared many of the features of more severe cases.  You could have a breast augmentation alone but some modifications to your breast shape could also be considered.  You have to consider the pros and cons of different scars versus shape.  Good luck.Dr Rodger ShorttPlastic Surgeon OakvilleDirector of Cosmetic Surgery Training,McMaster University

Dear BeebenThank you for your question and photo!  You have a couple of options for contouring your breasts- 1) implant, on top of the muscle, 2) micro fat grafting for breast enhancement along with the BRAVA for pre- expansion of the breast.With either surgery - a lift around the areola - will help with symmetry and overall breast shape.With Warm RegardsTrevor M Born MD

Hello Based on your photos , you have tubular breasts that could be treated with breast implants in conjunction with a mastopexy (breast lift) .We have quite a few patients with your concerns. A thorough consultation and evaluation would be necessary at which time comparable photos would be reviewed.Thank you

Based on your photos alone you do appear to have tuberous breasts. if you have the correction of your problem, realize that your breastfeeding ability will be decreased or impaired, and you may also have decreased sensation in your nipples after the repair.  It's a consideration that you have to take into account as the surgery will involve significant breast reshaping.It is important to seek a surgeon who has experience with tuberous breasts and who is a board certified plastic surgeon. I recommend seeking a few in person consultations to discuss your concerns and expectations - at this time you can ask each surgeon if they have experience preforming breast augmentation on tubular breasts and how many they typically preform. Click the below link to view before and after photos of patients who have under gone breast augmentation with tuberous breasts. Best of luck. 

Your breasts look saggy and could benefit from a lift. If you want larger breasts, then you can add an implant. Good luck.

Thanks for the photos.  As it is said "a picture is worth a thousand words".  The issues I observe from your photos include sagging of the breasts, large areola, laterally positioned NAC, asymmetry, constricted breasts and hypomastia.  A periareolar mastopexy, correction of constricted tight folds and breast augmentation should address the majority of your concerns.  I am in Buffalo, NY a little far from Toronto.  I have examples of this type of deformity on website.  Best of luck.

Thank you for the question and picture.  You are wise in doing your due diligence carefully when it comes to selection of plastic surgeon. Make sure that your plastic surgeon is a well experienced board-certified plastic surgeon with many demonstrable examples  of achieving the types of outcomes you will be pleased with. Often, just by evaluating a plastic surgeon's website you will be able to get a good idea of the surgeon's experience level. You may find the attached link, dedicated to breast surgery for patients with constricted/tuberous breasts helpful to you as you learn more. Best wishes as you reach your goals.

Dear beeben,

Thank you for your clinical post and photograph. From the photograph alone it does appear that
you have a tuberous breast phenotype appearance. This generally requires surgery that expands
the lower pole of the breast and to accommodate and make room for a breast
implant that provides the increased volume.
Occasionally, a formal mastopexy either periareolar or short scar with
breast augmentation is required. As
tubular breast augmentation can be quite challenging, selecting out the right
surgeon with both reconstructive and cosmetic breast augmentation experience is
likely in your best interest. One of the
best in Toronto would be Dr. Mitchell Brown at Women’s College Hospital. I have known him for two decades. He went to plastic surgery school at the same
time as me and is one of the best breast surgeons in Canada. I think a consultation with Dr. Brown will
give you the information that you can then use to decide if undergoing augment
and/or breast lift surgery is right for you.

I hope this information has been of some assistance and best
of luck.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto