Tuberous Breast Augmentation - Over or under the muscle? (Photos)

Question

Hello, I am looking to get a breast augmentation this winter. Wondering if over or under the muscle would be better, along with advice on profile (moderate vs full) that would best suit my frame based on my issues and starting point. I would like to go up 1-2 cup sizes and ideally semi-natural (won’t look bolted-on). Thank you!

Frank Agullo, MD · Answer

Nearly always over the muscle in a tuberous breast. The deformity gives you a narrowed base with the areola often herniating forward on top of the constricting band. If the implant sits above the pectoral muscle, it presses on the taut lower pole releasing the constriction.

On profile, moderate is almost always the safest bet on a tuberous breast. A higher profile increases projection right at the nipple and emphasizes any asymmetry between your areolas. Moderate gives you a smoother, more natural shape.

I routinely combine the augmentation with a small periareolar Benelli to flatten it. One stage, scar runs around the areola border. 1 to 3 cup sizes is achievable.

#StayBeautiful,

@RealDrWorldWide

Ted Eisenberg, DO, FACOS, FAACS · Answer

Under the muscle for the most natural look. Unfortunately, surgeons have created the term tuberous breasts, a fact which causes unnecessary concerns for women. Many women just have different sizes and shapes and in my opinion shouldn't be labeled. I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them.  Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Semih Yildiz, MD, FEPOBRAS · Answer

Implant position is only one part of correcting a tuberous or constricted breast shape. In the photos, the main visible issue appears to be a short/tight lower pole with areolar prominence and mild asymmetry, although an in-person exam is needed to assess tissue thickness, base width, fold position, and skin stretch.

For a natural 1-2 cup increase, many surgeons would consider a dual-plane/submuscular approach when upper-pole tissue is thin, because it can give better implant coverage; over-the-muscle can be reasonable only when soft-tissue coverage is adequate. Profile should be chosen from your measured breast base width rather than cup size alone, and the plan may also need lower-pole release, careful fold adjustment, or areolar reshaping if the constriction is significant.

Brian K. Reedy, MD · Answer

Thanks for your question! I think you would be a great candidate for a subfascial augmentation with Motiva implants. I would advise Demi (moderate) so that they don't look too augmented. Good luck!

Kadir Berat Oyur, MD · Answer

I can completely understand how frustrating it is to look in the mirror after your recovery and still see that persistent swelling, especially when your surgeon's office is telling you everything looks great. At just three months post-op, please let me reassure you that it is incredibly common to experience lingering fluid retention and uneven swelling, as the body's lymphatic drainage pathways take quite a bit of time to fully rebuild after a major surgery. What you are seeing is almost certainly a classic case of prolonged tissue edema rather than your final results, and it can take anywhere from six full months to a year for all that underlying fluid to completely dissipate and for the tissues to soften. I highly recommend sticking closely to your post-op hydration and low-sodium guidelines, continuing with consistent compression if still advised, and discussing specialized lymphatic drainage massage with your care team to help gently guide that stubborn fluid out and reveal the beautifully contoured result you worked so hard for.

Tuberous Breast Augmentation - Over or under the muscle? (Photos)

Answers (5)

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