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.

Because there is a wide range of appearances, from mild to severe, the surgical treatment for Tuberous Breast Deformity or TBD must address the following elements for a successful result :

Breast Base Grade: l,ll, or lllAsymmetry left and rightSkin envelopeAreola size, shape, herniation, and positionBreast volumePtosis (drooping)Breast fold position and size.Mild forms of TBD can be undiagnosed often leading to incorrect or incomplete surgery. The surgery must address all of the anatomical problems including: breast fold malposition, constricted or narrow breast base. Surgical procedures may include the following:

Implant aloneType and shape of implantOne or more stagesThe use of tissue expansion and implantsPocket placementPlacement of incisionsBreast lift and typeCorrection of the breast base and breast fold,Correction of the areola.

It appears that you need further surgery to reshape your left breast in particular as well as address the sagging. It is possible to achieve natural, beautiful results, you just need to find an experienced board certified plastic surgeon's help. Best of luck.

I see a lot of room for improvement in treating your tubular breast deformity. I would use a larger base diameter implant to improve your medial cleavage area. In addition, more lifting of your nipple/areola to centralize them and make them more symmetrical would be advised. As far as size, I would need to do an exam to get your dimensions, and assess your tissues and tone. But the answer is Yes, you can definitely end up with attractive breasts after surgery. 

The nipple needs to be in a specific position and then the breast tissue needs to be centered under the nipple & the implant centered under both for the best result. A large number of women do not have breast tissue centered under the nipple even if they have never had breast surgery. In these patients some adjustment of the breast tissue is required prior to placing the implant. There are a variety of procedures that can be used to change nipple/breast tissue position at surgery just before inserting the implant. Another problem is some women have breast tissue that is not centered under the nipple but this does not become apparent until after an implant is placed under the breast.

Looking at your photo the nipples are different distances from the midline and different distances from the notch above the breast bone. That would need to be corrected to some degree before placing breast implants. The photo looks like an incision was made in the lower half of the areola. That type of incision would not be expected to correct the nipple position. Unfortunately you will have to have the implants removed and then a breast skin/tissue procedure before replacing the implants in order to have an optimal result. As for how big an implant to place, that would depend on the size of the current implants and how much breast tissue is present.