Will tubular breasts look better with over muscle implants?

Thanks for your inquiry, the answer is that there is no one answer.  I have had excellent results with tubular breast both above and below the muscle, best of luck.

The goal is to alter and improve the shape of the breast.  I believe the implant has more influence on the shape of the breast when it is over the muscle.  Tuberous breast can be mild or severe.  In more severe cases I typically combine breast augmentation with a periareolar mastopexy.

Thank you for your question. Different sized implants can be used to achieve asymmetry. I would advise you to schedule a consultation with a board certified plastic surgeon for a detailed examination to discuss all possible treatment options and what your expectations are. 

Tuberous breast is not, technically speaking, a "yes" or "no" question. There can be different points on the continuum. The typical hallmarks include a high, tight fold with "puffy" or distended areola, minimal breast tissue and potentially herniation of the breast tissue through a tightened ring thus the "tuberous" label. It is a congenital deformity which usually manifests at puberty. To what degree it manifests will vary from one patient to the next.
Treatment of tuberous breasts varies depending on the degree of the breast architectural distortion. Surgical correction typically involves:
-areolar reduction
-submuscular augmentation
-release of constricted breast tissue
All of these techniques work in concert to correct the tuberous deformation of the breast.
With regards to your specific question, some in the past have advocated for subglandular augmentation ("overs") in the setting of a tuberous breast in the hopes of better expanding the lower pole. However, the rise of dual plan augmentation has supplanted this approach. It is the best of both worlds allowing for expansion of the constricted lower pole with none of the drawbacks of an "over" approach.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Verified Member
RealSelf Top 100
RealSelf Hall of Fame

Thank you for your question. Generally it is more common to use implants above the muscle for tuberous breasts in order to expand the lower pole easier, however it is not uncommon to place the implant in a dual plan position under the muscle  I recommend a periarelor approach as well  best of luck  

With dual plane augmentation, it is unnecessary to place implants in front of the muscle because of the increased risk and issues associated with subglandular implant placement:  increased risk of capsular contracture, rippling, implant palpability, premature aging of the breast, etc.The key with tuberous breast deformity is to release the lower pole bands, to correct the herniation of the breast tissue thru the areola and to expand the base of the breast.  All this can be done and a great result can be achieved with a dual plane placement of the breast implants.  There are different types of dual plane, Type I, II, III and each is suited for different issues.I would recommend you see a board certified plastic surgeon to examine you and to discuss your options.Hope that helps.

Hello and thank you for your question. It would be useful to see some photographs to give you a better advice. The key in surgical management of tuberous breast deformity is the release of lower pole to allow for better expansion. Generally speaking, there are advantages
and disadvantages to each technique and there is no one right answer that can
be given. Generally speaking, submuscular placement of the implant is
associated with less risk of capsular contracture, more natural upper pole
slope and less rippling/implant visibility. As there is a layer of muscle
separating the implant from the breast tissue, there will also be less interference
with mammograms. I would discuss all of these
with a board-certified plastic surgeon prior to making your final
decision. 
Best
wishes and good luck,
Pejman
Aflaki, M.D. Johns Hopkins-trained double board-certified plastic surgeon

This is a very interesting question and I am sure that you will get various opinions. When treating tuberous breasts, adequate release of the lower pole tissues, which are tight, is essential.Once the lower pole is expanded, the decision to go over vs under the muscle will depend largely on the thickness of the native breast tissue  in my opinion, if there is adequate soft tissue coverage (pinch test greater than 3cm), I prefer to go over the muscle using a more highly cohesive implant to limit rippling. Otherwise, I advise to go under the muscle. Lastly, I have found that most women with tuberous breasts get a better cosmetic result with moderate or lower profile implants which reduce the upper pole fill which can create a downward rotation of the nipple when the lower pole is tighter.Again, you will surely get various options in this forum and it is essential to discuss your specific case in person (or with a virtual consult) with a board certified plastic surgeon. Good luck

Thank you for sharing your excellent question.  In most cases the implants can be positioned either above or below the muscle in a tuberous breast with good results.  It is more important to focus on releasing the constricted tissues to allow the implant to stretch it over time than necessarily the position.  Hope this helps.

Dear natnat111111,
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.
Tuberous breasts can rarely be corrected without implants or at least a small one. The breast needs to be scored radially from the inside to expand it. If you don't place an implant behind the radial scoring it will fall back to its original state. You could theoretically remove the implant at a later day and graft with fat but that would be a separate surgery.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery