Tuberous Breasts Surgery!- Tell me about cutting or releasing constricted bands that cause tuberous breasts
Doctor Answers 5
The tuberous breast deformity can have a wide variety of presentations but essentially consist of three basic elements: 1st, the constriction or underdevelopment of the breast causing it to look narrow or short; 2nd, herniation or bulging of the nipple/areolar complex (NAC); and 3rd, drooping. Size differences are also a common issue but the constriction is the more challenging problem. Scoring of the inside of the breast is a common way to expand the breast but can be unpredictable and may require revisional surgery later and, of course, would necessarily require placement of a scar in order to achieve access to the under surface of the breast where the scoring would occur. The real question is, if you do not desire a reduction in the herniation of your breast or an increase in the volume or cup size of your breast, why do you want to have your breast corrected, since scoring alone will likely not significantly change your breasts other than to possibly decrease the prominence of your defect?
The constriction deformity or narrowing of the base of the breast can vary significantly from patient to patient and even with each breast on the same woman. The amount of constriction will have an impact on how your deformity can be managed and in your case is difficult to ascertain as no photographs are present. It also appears that no change in breast cup size is desired either as you have not alluded to this in your question. In the most severe cases, surgical management is almost always required. This would involve reducing the herniated defect of the areola in addition to elevation of the position of the nipple complex as this often droops below the level of the inframammary fold (IMF). However, it is this fold position that can be so challenging since this is a relatively non-movable part of the breast and is often excessively high on the chest in the first place thereby restricting management - including placement of an implant if this is chosen. It is the relative position of the NAC and the fold, which defines part of what makes a breast attractive. So if the fold is too high but the NAC is in proper position, the breast can still appear as though it is drooping because the high fold makes the NAC appear low. In this case, a mastopexy or breast lift could be performed but expansion of the lower portion of the breast and lowering of the IMF is necessary in order to achieve an attractive contour especially if an implant is to be used. In many cases, scoring alone can improve the position of where an implant would normally sit in a constricted breast. However, if the tuber (bulb like shape) of the breast is so confining and herniated, additional surgery will likely be required. This may involve the use of tissue expanders, local flaps of tissue, or even bringing tissue from other areas of the body. Most women who have a constriction or tuberous breast deformity desire not only a reduction in the NAC and mastopexy but also an increase in breast volume as well. Since you apparently do not desire any scar placement on your breast, I would anticipate that your deformity is mild, however without photographs, it is impossible to make an evaluation.
There is another alternative treatment which is called BRAVA. This is a device that uses negative or vacuum pressure to increase breast volume. With daily and dedicated use of the BRAVA domes (which are large plastic cups lined with silicone stripping to create a seal against your chest) enlargement of the breasts will occur in a matter of weeks. The only problem is that once women stop using them, the breasts usually return to their original size - although some believe there is actually a long term increase in breast size. A current application of this device includes expansion of the breast with the addition of autologous fat grafting. In a patient who has a constriction deformity, release of the constricting bands can be performed through a process of what is called “Rigottomies”, where a needle is inserted through the skin directly over the many constriction bands thereby puncturing the restrictive bands to allow expansion internally. These puncture marks heal without any evidence of scarring. With this process, the restrictive bands have now been expanded to a mesh like structure which is also thought to be more receptive to the fat grafting parcels. Even more exciting is that the use of BRAVA expansion has been shown to improve the outcome and survival of autologous fat grafting. This combination technique, developed by Dr. Roger Khoury in Miami, essentially allows the transfer of millions of small parcels of your own body fat to be transferred to your breasts very much like planting seeds in the soil. When done correctly, the majority of fat integrates within the surrounding healthy tissue and, when retained, has the potential to last a lifetime. In my experience with this method, I have see the results of BRAVA and fat grafting and have found them to be consistent, long lasting and natural! The results with this approach allow your breast to be enhanced in a totally natural way with scars that are virtually undetectable and the fat allows the breasts to feel as soft as your own breast! The procedure is performed in an outpatient setting and, as an extra bonus, includes liposuction like results in the donor sites. In patients who have asymmetries or drooping, improvement of the breast through this natural methodology can be even more amazing. Although BRAVA can be aggravating to use, its application in fat grafting is usually worth the effort and in a situation like yours, is almost essential. It is important to understand, however, that the use of Brava expansion with rigottomies is intended for a patient who desires to enhance the volume of their breast at the same time that in improvement in contour is achieved. You have not indicated if you desire it an increase in your cup size and, therefore, if no expansion is undertaken, correction of the breast deformity may not be practical. I hope this helps and have a wonderful day. Dr. Kayser
Tuberous Breast Augmentation / Reconstruction
Treatment for tuberous breast depends on the amount of breast tissue present, the pliability of the soft tissue, and the breast shape. The constrictive ring is broken up by dissecting the breast tissue from the underlying muscle and making radial incision. This technique enables the breast tissue to lay in a more circular fashion. A nipple reduction is often an integral part of this surgery as is, at times, a breast lift.
The surgery can be done in one or two stages with or without a breast implant. Tissue expansion is necessary sometimes to prepare the breast envelope to receive an implant.
Seek consultation with a board certified plastic surgeon for more information. I hope that this was helpful!
To best help you, a physical examination or picture evaluation is required in order to determine which procedures and techniques would be best for your case and that way give you the best review.