Tuberous Breasts Surgery!- Tell me about cutting or releasing constricted bands that cause tuberous breasts

The tuberous breast is a congenital malformation of the breasts that is thought to be caused by a constrictive ring of fascia around the breast tissue underneath the skin. This prevents the present tissue from expanding and developing properly and often leads to herniation of breast tissue through a large areola. There is a spectrum of how much this ring ends up restricting breast growth. 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!

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