Small, tubular, breasts, large areolas, far apart with low nipples. What treatments will not include an implant? (photo)

I've always had small breasts and a comparatively large areola. It is only recently that I've become aware of tubular breast deformity and I think that I may have it. My breasts aren't very saggy, but they are kind of far apart and the nipple is low. The part that really bothers me about them is the areola size. Do you think that my breasts are tubular? Do you think I would benefit from an areola reduction? What other treatments are available? I'm not interested in getting implants.

Doctor Answers 8

Treatment of tubular breasts without implants and areola reduction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Treatment 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 lll
  • Asymmetry left and right
  • Skin envelope
  • Areola size, shape, herniation, and position
  • Breast volume
  • Ptosis (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 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.
  • The use of fat grafting or natural breast enhancement to help shape the breast with or without implants

Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Tubular breast

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There are a number of features that define a tubular breast:
•Wide and puffy areolae
•widely spaced breasts
•high breast fold
•constricted lower pole (deficient tissue in lower half of the breast
•minimal breast tissue
•high breast fold
•narrow base of the breast

From the photos, you seem to have most of these features. 


The surgical options are numerous and may be complex, and as always would depend upon the patient's goals. A breast lift could reduce areolar size and improve the position. Breast implants could provide added volume as well as improve the shape and to a small extent the position of the breasts, but are of course not necessary. Fat injections can also be used to increase volume.

When you ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S.
Thank your for your question, best wishes.


Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Yes, it appears that you have a mild form of tubular breast deformity

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}


Thank you for your photos.  Tubular breast deformity is much more common than people suspect and can be found in all varieties of severity.  What you exhibit is a mild form or tubular breast deformity.  It can be corrected well by expert hands using either an implant and breast tissue modification (scoring) as well as an areolaplasty or it can be corrected by several sessions of fat grafting.  Whatever you decide I would encourage you to educate yourself about your options and seek several consultation with board certified plastic surgeons that have good experience and results with these procedures.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Tubular breasts?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your breasts have mild components of this issue.  An areola reduction can be performed in conjunction with implants if you desire. The very wide spaced breasst can be improved somewhat with implants as well.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Tubular breasts

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your posted photos show significant asymmetry with the breast tissue on the right at and below nipple level while that on the left is at and above nipple level. On front view the breast mounds seem widely separated but on oblique view you can see the bases of the breasts are closer together and it is the shape of the breasts outside the bases that makes them seem widely separated. I suspect the left breast crease is higher than the right one. With or without implants surgery will not be easy and it is clear that implants alone will be insufficient.

At a minimum some cuts will need to be made in the breast tissue below the level of the skin to reshape them.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Tubular breast deformity

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hi there

You definitely have tubular breast deformity.  As you have good volume it can be well corrected through a periareolar incision, which can also correct the areolar size and breast asymmetry. If you have health insurance there is an item number which means that insurance coverage applies to the hospital costs of treatment.  Best thing to do is, when you're ready, is have a consultation and find out more about correction in specific detail.

good luck

Tubular breasts

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for the inquiry and photos for review.  It does appear that you have mild form of a tuberous breast deformity.  Your breasts have several characteristics which are consistent with this diagnosis:

  • wide gap between the breasts
  • small breasts 
  • large areola
  • constricted breast base (narrow base of the breast with a short distance from the Nipple / areola complex to the fold under the breast, with minimal breast tissue in this area)

Of course, nothing replaces an in-person consultation, however if you are truly not interested in a breast augmentation with implants, there are other options today.  I would offer you another possibility which would involve liposuction (of areas of your body with unwanted fat, you would get the benefit of body sculpting of these areas), this fat would be harvested and utilized as injected fat grafts to enhance your breasts with your own tissue.  This is an exciting procedure which could help you achieve, fuller, rounder breasts, without the use of implants while alleviating the breast issues associated with tuberous breast deformity.  An areola reduction procedure could be combined as well.


good luck

Dr. Sean Simon

Tubular Breasts?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for the question and pictures.

I think your breast photos do demonstrate some of the characteristics seen with tubular (constricted) his breast. For example, the distance from the areola to inframammary folds seems to be tight and relatively short.  Your inframammary folds seem to be widely spaced from the midline of your chest. The areola do demonstrate some features associated with tubular breast such as  an increased width  and “puffiness”.

 You will benefit from an in-person consultation with well experienced board-certified plastic surgeons. This consultation will allow for accurate advice that is best provided after a thorough history, physical domination, and detailed discussion of your goals. There are a lot of factors to consider when making recommendations; for example your life circumstances ( planned pregnancies, psychosocial situation…) and tolerance for scars  are factors that should be taken into consideration by you and your plastic surgeon.

I hope this helps.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.