Tuberous breasts or not? Do I need a lift? (Photos)

Question

35, 2 children. I've had two consults with differing suggestions. Doctor #1 said the breasts are tuberous and suggested a mastopexy with fat grafting or implants. Doctor #2 disagreed that breasts were tuberous, specifically saying they were not. They recommended staging out with implant first and following up with a lift if I felt I needed one, so two surgeries, to promote healing in between. Are they tuberous? Do I NEED a lift?

Harry T. Haramis, MD, FACS · Answer

If you are ok with lower, more natural looking breast, in my experience, implants placed dual plane (half under muscle) can re expand without formal breast lift. Your breasts appear slightly tight at the lower poles, they do not seem tuberous in photos

If you want, high, tight and perky breasts, then implants with lift/mastopexy together would be best.

In either case, fat transfer may be substituted for breast implants.

Further consultations are recommended until you feel comfortable.

Joel Patrick Maier, MD · Answer

I would not call your breasts tuberous, but they do have some degree of ptosis. Depending on your desires and expectations; an appropriately sized implant will provide shape and fullness in the cleavage line. The implant will help fill the skin and nipple areolar complex and this may be enough for you. Having said that, you nipple-areola complex has some ptosis and to maximally rejuvenate and shape the breast, a vertical mastopexy (lollipop lift) will be the correct option. I hope this helps, thank you for the inquiry!

Caner Kacmaz, MD · Answer

I agree with the first surgeon. You definitely have tubular breasts and you need uplift with implants for the best outcome. Best of luck to you

Emre Guvercin, MD, FEBOPRAS · Answer

From what you’re describing, this sounds much more like post-pregnancy breast descent and shape change than a true tuberous breast deformity.That’s why you’re getting conflicting opinions &mdash; borderline cases are often mislabeled as “tuberous.”What defines true tuberous breastsTrue tuberous (tubular) breasts typically have:Constricted breast base (tight lower pole)Herniated / puffy areolaMinimal lower-pole development from adolescenceA breast that never fully developed normallyThese features are present since puberty, not acquired after pregnancy.If your breasts:Developed normally before childrenChanged mainly after breastfeeding and weight changesFeel deflated or descended rather than “constricted”→ then this is not classic tuberous deformity.So why did one surgeon call them tuberous?Some surgeons use “tuberous” as a catch-all term for:Deflated lower poleAreolar stretchingLoss of upper-pole fullnessBut those features can occur without true tuberous anatomy, especially after pregnancy.Labeling matters &mdash; because it changes the surgical plan.Do you need a lift?This depends on nipple position and tissue descent, not the name of the condition.If:Nipples sit at or below the inframammary foldBreasts look bottom-heavy or deflatedUpper pole is emptyThen yes &mdash; a lift is functionally needed to restore shape.An implant alone:Adds volumeDoes not reposition tissueOften worsens sagging over timeFrequently leads to a second surgery anywaySo the “implant first, lift later” approach often just means two operations instead of one.What’s the most balanced approach hereFor cases like yours, the most logical solution is often a Push-Up Breast Lift, with or without a small volume addition (fat grafting or a modest implant).A Push-Up Lift:Repositions your own tissue upwardRecreates lower-pole shapeImproves areola positionRestores upper-pole fullness naturallyAvoids over-reliance on implantsCan correct mild “pseudo-tuberous” appearance without labeling it as suchFat grafting can be added if volume is truly lacking &mdash; but it works best after the breast is in the right position.About staging surgeriesStaging (implant first, lift later) is reasonable only if:Sagging is truly minimalThe patient strongly wants to avoid lift scars nowThey accept a high chance of a second surgeryIf your anatomy already shows descent, staging usually means:paying twice, healing twice, and still needing a lift.

Ellen Ozolins, MD · Answer

Thank you for your question. It seems you don't have true tuberous breasts. However, you would benefit from a breast lift with implants, as your nipples are positioned below the breast fold, and you have noticeable sagging and loose tissue. If you're unsure about proceeding with a breast lift, you can stage the procedure by starting with implants and reassessing the results later. This approach allows you to see if the added volume alone meets your goals, without the extra scars from a lift. If, after some time, your breasts still sit low or you desire more lift, you can consider a breast lift at that point.

Gregory Lakin, MD · Answer

Thank you for your question. From your description and photos, you don't appear to have tuberous breasts. However, you do need a breast lift with the implants because your nipples are positioned below your breast fold. Without the lift, your breasts may become larger but still sag. A mastopexy will help position the nipples higher and give you a more natural shape. Consult a board-certified surgeon to assess the shape, base width, nipple position, and overall breast tissue to determine your best option.

Daniel Barrett, MD · Answer

Dear Genuine627215,

tuberous breasts are not simply small or underdeveloped breasts. The appearance of the breast can range from mild to severe, and typical traits include: enlarged, puffy areola, rather wide spacing between the breasts, very little breast tissue, sagging, higher than normal inferior breast fold, and narrow base at the chest wall.
The type of surgery best for you will depend on the severity of your condition.
My preferred technique for tuberous breast correction involves a multistep procedure where the breast tissue is released in a radial pattern to prevent herniation into the areola and placement of a custom implant size is in the breast to allow appropriate expansion of the breast in the restricted dimensions. This can often be done in a single procedure but sometimes may require two surgeries.
That said, it is best that you visit a board-certified plastic surgeon for an in person examination. Only after a thorough examination you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Leila Kasrai, MD, FRCSC · Answer

Your breasts don’t appear to be tuberous since you have a defined breast fold and there is no constriction of tissue around your nipples. A lift would be recommended, as your nipples are located below your breast fold.

Jeffrey M. Darrow, MD · Answer

Thank you for your photographs. I do not see that you have tuberous breasts.  The only ptosis of your breasts I see is a small amount of the glandular portion of your breast. It appears that your nipple is above the level of your inframammary fold. A breast augmentation will give you a larger version of your present breast.  If this is acceptable to you, nothing else needs to be done.   As your nipple position is presently acceptable, but perhaps, slightly lower than ideal, you could consider having a crescent breast lift with your breast augmentation. A crescent breast lift can elevate the nipple up approximately 2 cm and the incision line is hidden right along the color difference between the darker areolar skin and the lighter breast skin and is very well camouflaged.   If you wanted to hold off having the crescent breast lift done until a later date, this is easily accomplished under local anesthesia with minimal downtime.

Gulcin Nujen Cardak, MD, FEBOPRAS · Answer

Hi, according to your pictures, my opinion is that you have a mild tubular breasts. Breast implants will be perfect solution for you. According to my experiences after breast augmentation surgery there won’t be any need to get lifting surgery but if needed you always can get lifting surgery.

Gary M. Horndeski, MD · Answer

Your breasts are not tuberous, they are just low on the chest wall and ptotic. You appear to have pseudoptosis which is were the nipple is at about the level of the fold. The technique I recommend is a lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Tuberous breasts or not? Do I need a lift? (Photos)

Answers (21)

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