Can Tubular Breasts Ever Look Pretty?

There are several things that create the undesirable aesthetics.  Firstly the implant base width appears to be too narrow for your chest wall dimensions.  Secondly the inframamary fold needs to be lowered.  Thirdly, you have undesirable lateral inferior stretchning that is very common with dual plane placement.  Placing breast implants under the muscle creates a few aesthetic problems. If you look at your picture, your breasts are too far apart at midline to have a natural appearance.  any time your arm moves this appearance will widen and worsen.  This is the reult of releasing the inferior portion of the pectoralis major muscle.  The more superior origins will not allow the implant to sit in a natural place and the continual forces of the muscle constantly push the implant down and out.  When this is combined with excessive undermining of the inframammary fold, the deformity that you are seeing results and continues to progress.  This is a very common finding with submuscular placement.  To understand these forces better, stand in front of a mirror topless, put your hands on your hips and push down onto your hip bones firmly.  You will see both breasts move down and out.  these forces over time always cause lowering, lateral displacement, thinning of the breast tissue and stretching of the skin.  This is the reason that I use a unique technique in my practice called 'cold-subfascial augmentation.' THis technique leaves the muscle alone and out of the equation but should not be confused with 'above the muscle' which I would also not recommend.  The cold-subfascial augmentation harnesses the strong structural power of the pectoral fascia to create a truly natural breast shape and act as a living structurally sound brassiere inside the breast protecting the breast from the pressure of the implant and forces of gravity.

I have seen many patients with identical problems to the one you present and in my opinion there is only one good solution- changing placement to a new cold-subfascial plane. I also use a unique technique to add symmetry to the nipples and reduce the areolas with a hidden scar and no circular scar around the areola. I hope this helps!

All the best,

Rian Maercks M.D.

Regarding: "I had surgery 3 years ago and I noticed them starting to go back to the way they looked before the surgery. I'm thinking about going under again..but is it worth it? will they ever look normal? Is it possible for them to be closer together? and how big should I go without them looking terribly fake?"

Your breasts COULD look a lot better but it require attention to detail. It will not be accomplished by simply going UNDER or bigger but by correcting what was not corrected well in your first operation.

Your tuberous breasts are STILL tuberous or constricted. The constriction bands along the lower half of the breasts , seen in ALL cases of tuberous breasts, need to be divided to allow distention and expansion of the lower pole of the breasts by the implants. The implants you currently have look fake because they do not equally fill the breasts and are pushed up in the breast (this is especially seen on the breast on the right side of the picture which is way high).

The implants should NOT be closer together. That would make things MUCH worse. The implants need to be centered under your nipples - wherever the nipples lie. If the implants are large and closer together to simulate "cleavage" the nipples would be on the sides of the breasts looking worse than they are now.

You can have a nicer result but your surgeon needs to understand what needs to be corrected to get you from where you are to where you could be.

Good Luck.

Dr. Peter Aldea

I think your previous surgeon might possibly have been out of their league with your surgery.  You can have revision of the implants, and you need lifting and this can improve the result.  Don't try to fix this with overwhelming volume.  Go to the very best plastic surgeon in your region and know that you can't be perfect with tubular breasts (a tough starting point!) but your result should be much better than it is.

• Breast Base Grade: l,ll, or lll
• Asymmetry left and right
• Skin envelope
• Areola size, shape, herniation, and position
• Breast volume
• Ptosis (drooping)
• Breast fold position and size.

• Implant alone
• Type and shape of implant
• One or more stages
• The use of tissue expansion and implants
• Pocket placement
• Placement of incisions
• Breast lift and type
• Correction of the breast base and breast fold,
• Correction of the areola.

Thank you for the question and picture.

Although the results of  breast surgery in your case will never be “perfect”,  I think there is certainly room for improvement. Please do your due diligence and find a well experienced plastic surgeon with significant demonstrable examples of his/her work.

Best wishes.

Yes, I agree that your breasts can be improved.  Although correcting the tubular breast deformity can be challenging, it can be done to make your breasts become more symmetric and "pretty."  By placing larger implants and bringing the implants together as well as performing circumareolar mastopexy and releasing some of the constructed breast tissue, your breasts will look better.

Tubular breast correction is one of the more difficult corrections in plastic surgery, but YES they can look quite normal after appropriate surgery. The issues with a tubular breast are typically a herniation of breast tissue into the areola, an elevated inframammary fold, and a shortened amount of breast skin between the bottom of the areola and the inframammary fold. Correction for mild cases often involves a release of the internal tethering to correct the herniation and a lower of the fold with implant placement. In more severe cases, a two-stage approach may be necessary with the use of a tissue expander to expand the skin in the lower pole and essentially reconstruct the breast. It is important to consult with a Board Certified Plastic Surgeon with extensive experience in repairing these types of breast deformities.

I agree with Dr. Aldea, it appears from your photos that you did not initially have adequate treatment for your tubular breasts. Generally my approach is to release the constricted narrow inferior portion in a subgladular plane with a superior portion of the prosthesis being placed submuscularly. This allows for generous superior coverage. If there is herniation of the breast tissue beneath the areola, this can be de-bulked and a periareolar mastopexy then performed. There is usually a deficiency of skin in the inferior portion of the constricted breast. In your case, at this point in time, replacement of your prosthesis with a careful capsulotomy and periareolar mastopexy on the right side would help. On the left, in order to get complete elevation, you would require a small vertical component, (if the skin allows) and a bit of de-bulking of retro areola tissue. This should be performed by someone who feels comfortable and has experience with your situation.

You do have quite a discrepancy between your breasts. I am sure that they could be made to look better as well as more the same through various techniques. Since they have already stretched with present implant, you can also go larger. Watch my videos.