Are these tuberous breasts?

Question

I have dealt with this TBD for years, and as of late is has caused me great pain due to chest restriction in the areola region due to the cone like shaping of the breast. . I am looking to seek contraction relief and reconstruction of the breasts. If applicable, I'm seeking the process or Route of Diagnosis, likelihood of being able to deem my pain as medically necessary for insurance coverage, the process with out of network providers and specialists

Elizabeth Kiwanuka, MD, PhD · Answer

Dealing with tuberous breast deformity and its associated discomfort can indeed be challenging. To address the pain and restriction in the areola region caused by the conical shape of the breast, several steps can be taken towards diagnosis, treatment, and potentially getting the procedure covered by insurance.
Diagnosis: The first step is to get a formal diagnosis from a qualified plastic surgeon or a breast specialist. They will examine your breast anatomy, discuss your symptoms, and confirm whether your condition fits the criteria for tuberous breast deformity.
Medical Necessity for Insurance Coverage: Once diagnosed, your surgeon can help document your symptoms and the necessity for surgery, which is crucial for insurance purposes. Chronic pain and physical restriction are key points that can help classify the surgery as medically necessary. It’s important to gather as much medical documentation as possible to support your claim.
Out-of-Network Provider Process: If you choose a specialist who is out-of-network, you’ll need to understand your insurance plan's benefits for out-of-network care. This might involve higher out-of-pocket costs, and pre-approval or a referral may be necessary. Contact your insurance provider to understand the specifics, including deductibles and co-pays.

Gary M. Horndeski, MD · Answer

Your breasts are not tuberous but are small and widely separated. You will need a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, fat transfers or small implants can be placed if additional volume is desired. Insurance companies will not cover this procedure.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Gerald Minniti, MD, FACS · Answer

You have mild to moderate breast constriction, aka tuberous breasts. Although you may be feeling pain, it is not common among women with tuberous breasts. Treatment of tuberous breasts has always been cosmetic, and any procedure we could perform, including placement of implants, fat grafting, or breast lifts would not reliable alleviate pain. Further, insurance companies recognize the things I've said to be true, and will not pay for cosmetic surgeries for the purpose of pain reduction.

Steve Laverson, MD, FACS · Answer

Although you have what appears to be very mild constriction across the infra-mammary fold and lower pole of your breasts, NO, yours are not frankly tuberous and appear symmetric and aesthetic.  Your mammary parenchyma (breast glandular tissue) is centrally distributed around and behind your areolae, and should be more widely re-distributed during breast augmentation for cleavage.

Zoran Potparic, MD · Answer

Based on this photo you seem to have narrow base breasts and slight breast asymmetry. This type of breast deformity is within tuberous breast category. It is unlikely that insurance would cover  for correction which should include breast tissue reshaping, augmentation with implants and reduction of areola. Hope this helps.

Ram Kalus, MD, FACS · Answer

An evaluation in person would be required to properly evaluate you and make specific treatment recommendations. The determination of “tuberous breasts” is primarily a descriptive term encompassing a variant of normal breasts wherein the subareolar tissue may protrude or “herniate” and the distance from the nipple-Areola to the inframammary fold (bottom of the breast” is relatively short or (constricted). Pain and discomfort from the breasts is generally not part of the diagnosis, and therefore the correction is unlikely to be viewed by your insurance company as “medically necessary”.

That is not to imply that your symptoms are not real. Your breasts may indeed be a source of discomfort and this can have a hormonal basis and an evaluation by your family doctor or OBGYN is warranted.

A board certified plastic surgeon can evaluate your breasts and advise you on possible treatment options for correction, but that recommendation is unlikely to include a promise of improving your symptoms with regard to pain or discomfort.