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

Gregory A. Buford, MD, FACS · Answer

Great question!

In your case, I would do the following:
-Submuscular Augmentation (via IMF approach) w/lowering of the breast fold
-Periareolar Reduction w/glandular scoring to the lower pole

I also emphasize to all of my patients with Tuberous Breast that they may ultimately need a second surgery if the lower pole tissue doesn't completely expand as we'd like.

For this type of procedure, it is rare to find someone who operatives on TB's on a routine basis and so a Board Certified Plastic Surgeon who specializes in revisional breast surgery would be your best bet for success.

I hope that helps and wish you the very best!

Natalie Plana, MD · Answer

Thank you for sharing your photos and goals. Based on your starting point, some of what you're describing is consistent with a constricted, or tuberous, breast pattern, which is simply a common variation in how the breast tissue developed. For this anatomy, my preference is a submuscular (under the muscle) approach combined with radial scoring of the tight tissue, which reshapes the lower pole itself rather than just placing volume behind an unchanged shape. I often pair this nicely with lateral liposuction to refine your overall frame for the semi-natural look you're going for. Moderate versus full profile will come down to your chest width and breast base measured in person, but I think a one to two cup size increase with this approach could look really beautiful on you.
Please note that any thoughts shared here are based solely on the information and photos provided in this post, and are inherently limited without an in person examination. A definitive surgical recommendation can only be made following a full consultation and assessment with a plastic surgeon.

James N. Romanelli, MD, FACS · Answer

Thank you for your question.

WIth your breast shape and chest shape you should consider subfascial placement of implants.  Tissue and areoles can be modified as needed.  Implant profile will depend on the size you choose.

Best of Luck
Dr. Jim Romanelli

Emre Guvercin, MD, FEBOPRAS · Answer

For a tuberous breast deformity, the decision is not simply "over" versus "under" the muscle&mdash;the key is correcting the constricted breast shape. Based on your goals of increasing 1–2 cup sizes while maintaining a natural appearance, I would favor an over-the-muscle (subfascial) approach rather than routine submuscular placement. In tuberous breasts, the problem is often a tight lower pole and areolar herniation, and placing the implant under the muscle does not fully address those issues.A Motiva Ergonomix Demi implant would typically be a very reasonable choice for achieving a soft, natural result without looking overly projected or "bolted on." To properly address the tuberous anatomy, I would also consider a periareolar lift/reduction to correct areolar herniation and improve areolar shape. In addition, fat grafting to the lower pole and cleavage area can be extremely helpful for releasing the constricted lower breast, improving contour, and creating a smoother transition between the native breast and the implant.The best results in tuberous breasts usually come from treating all components of the deformity&mdash;implant selection, areolar correction, and lower-pole expansion&mdash;rather than relying on implant placement alone. This combination generally provides the most natural and balanced outcome.

Daniel Barrett, MD · Answer

Dear PessimisticallyHopeful,
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.
The type of surgery best for you will depend on the severity of your condition.
My preferred technique for tuberous breast correction involves a multistep procedure where the breast tissue is released in a radial pattern to prevent herniation into the areola and placement of a custom implant size is in the breast to allow appropriate expansion of the breast in the restricted dimensions. This can often be done in a single procedure but sometimes may require two surgeries.
That said, it is best that you visit a board-certified plastic surgeon for an in person examination. Only after a thorough examination you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Vasileios Vasilakis, MD, FACS · Answer

Hello,
Thank you for the question. Based on your photos, subfascial position will likely create a better shape, although an in-person examination is needed to confirm this. 
I wish you the best. 
Vasileios Vasilakis, MD, FACSDouble Board Certified Plastic SurgeonHouston, TX.

Zoran Potparic, MD · Answer

It is not clear whether your breasts could be considered a typical tuberous breasts except for large areolas? Regardless, correction should include augmentation and possibly, reduction of areolas. In your case, based on these photos,  I would consider submuscular augmentation considering that you have relatively small amount of breast tissue. However, placement on top of muscle is quite acceptable. I would choose moderate plus profile in the range of 300-350 ml. I hope this helps. Good luck.

Christine Fisher, MD, FACS · Answer

Thank you for your thoughtful question. Tuberous breast deformity can present with a wide range of anatomical variations, and I commend you for taking the time to research your options and better understand the available corrective procedures.

Correction of a tuberous breast deformity is often more complex than a standard breast augmentation and typically requires a customized surgical approach tailored to your specific anatomy and aesthetic goals. In many cases, treatment involves not only placement of a breast implant to improve volume and upper pole fullness, but also surgical reshaping of the breast tissue itself to release the constricted lower pole and create a more natural breast contour.

Depending on the severity of the deformity, surgical techniques may include lowering or redefining the inframammary fold, radial scoring or expansion of the constricted breast tissue, enlargement and reshaping of the lower pole, reduction of areolar diameter if enlarged, and careful implant selection to improve symmetry and proportion. Based on your photos, you will need a certain width of implant to fill out the footprint of the breast, which likely will not be acheived with a high profile implant.  As far as above or below the muscle, I peform the majority of my augmentations in a subfascial plane while utilizing a micro-dual-plane technique to provide a smoother upper pole transition.

The most important aspect of treating tuberous breasts is developing an individualized surgical plan based on your anatomy, skin quality, degree of constriction, asymmetry, and desired outcome. Because these cases can be technically challenging, I would strongly encourage you to seek consultation with an experienced board-certified plastic surgeon who has specific expertise in breast and body surgery and is comfortable managing tuberous breast deformities.

With thoughtful surgical planning and appropriate technique selection, significant improvements in breast shape, symmetry, and overall aesthetic appearance are often achievable.

Best wishes as you continue your research and decision-making process.

Donovan Rosas, MD · Answer

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.

Based on your photos, you would benefit from all the above listed interventions. Profile choice is patient dependent given a certain BWD.

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

Mehmet Ozdemir, MD · Answer

It is completely understandable to feel a bit hesitant when researching breast augmentation, but your anatomy is a beautiful starting point that can be wonderfully optimized with the right surgical technique. Looking at your photos, you exhibit a mild variant of tuberous breast anatomy, characterized by a slightly constricted lower breast base, a high inframammary fold (the crease under the breast), and herniation of tissue into the areola. To achieve the semi-natural, non-"bolted-on" look you desire while gaining 1 to 2 cup sizes, a **dual-plane, submuscular (under the muscle)** placement is highly recommended; placing the implant partially under the pectoralis muscle provides essential upper-pole coverage to ensure a soft, natural slope, while the surgeon will carefully score and release the tight, constricted lower breast tissue from the inside to allow it to expand smoothly over the bottom of the implant. For your specific frame, a **moderate-profile or moderate-plus-profile cohesive silicone gel implant** would be ideal rather than a high-profile one, as it offers a wider base diameter to physically expand your narrow breast footprint and fill out the lower hemisphere naturally, giving you a beautiful, soft, and completely seamless transition.

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

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