5'11", 34 yo, wide chest, tuberous breasts, implants with lift, 445cc under muscle, silicone

I am starting this review because I had found it difficult to find many stories of women with tuberous breasts, and I'm hoping my journey helps someone.

I have a wide chest/shoulders, with AA tuberous breasts. I wanted primarily to change the shape of my breasts and increase their size to a full B or a small C.



Finding a surgeon felt like an insurmountable task, with everyone saying: do your research! But I felt like I had no idea where to start, and there were SO many surgeons to choose from. I found a helpful website. I started with that website to narrow down top surgeons in my area, then looked closely at their reviews on each site before scheduling consultations with three of them.



The first surgeon I went to recommended that I have 300 cc implants over the muscle with fat grafting to smooth out the shape.



The other two surgeons I went to said that for my chest size and tuberous tissue, the implant would need to be larger (between 425 and 495 cc depending on profile choice) and they recommended the implants be made under the muscle. They also both agreed that I would need a periareolar mastopexy (what they called a "pseudo lift") which included radial scoring of the lower pole to actually change the shape of the breast to be more round.



The rationale and explanations of the latter two surgeons made more sense to me, given my situation, so that is the method that I chose. I'll write a separate post about how I decided to choose between the two latter surgeons, in case that helps.

I went to three consultations with three different surgeons, and in the end I chose Dr. Brian Coan at CARE plastic surgery.

The first surgeon I went to for a consultation was very underwhelming. The surgeon didn't take any measurements, didn't have any pictures of other women with tuberous breast tissue that he had performed surgery on, and follow-up with the office was lack-lustre.

The second surgeon I went to for a consultation started out with him talking at me for 35 minutes, all basic information about breast augmentation that I had already read. He then took measurements of my chest and made a suggestion on implant size based on the measurement. I didn't feel as though he was able to thoroughly answer my questions, and he only spent about 2 seconds looking at the images of what I wanted. He was also suggesting a higher profile/higher cohesion (moderate plus) implant, which I felt uncomfortable with because I want them to look as natural as possible. Follow-up questions with the office went unanswered/were answered with vague non-answers.

My third consultation, with Dr. Coan, was like a breath of fresh air! First, upon scheduling the consultation, I was asked to send over pictures of myself so Dr. Coan could do a preliminary evaluation. Then, they sent me a series of videos and informational packets, which I thought was incredibly thorough, and made the consultation itself much more specific to my wants/needs and questions/concerns, rather than spending so much time on general information. The office then asked me to type up and send over any and all questions I have so that they can review them before the consultation, and I sent over my "wants" and "don't wants" for results.

During the consultation, Dr. Coan took several different measurements of my chest and breasts, took more photos, and discussed my specific wants and questions. He then showed me pictures of several women who had tubular breasts and their results, highlighting what he did/the limitations of each. Dr. Coan stressed that he would not be able to achieve perfection, and that I needed to lower my expectations. He said that he would be able to achieve improvement, but not perfection. Tuberous correction is difficult, everyone heals differently, and there is only so much change in breast shape that is possible with constriction. I appreciated his honesty here, and mentally, this will help me during the post-operative recovery phase.

After the initial consultation with Dr. Coan, I went into another room with his nurse, Kendall. She was amazing. Very kind, patient, and also equally thorough. She showed me the size charts and explained what Dr. Coan was recommending and why: Dr. Coan recommended 490 cc Inspira Responsive Gel Natrelle silicone implants.

The size is much larger than what I originally wanted, but both Kendall and Dr. Coan explained that in order to have the best chance at correcting the tuberous shape, the implant needs to be larger. As I tried them on, he said that some of their size would be smaller from the muscle's constriction, and that I would be looking at a large C or small D in the end. He recommended the responsive gel (less cohesion) instead of the "soft-touch" (more cohesive) because my main goal was a more natural look in the end.

My follow-up questions were answered by Kendall, who called me personally and explained everything in detail. I felt listened to, and I feel as though I trust the professional and medical opinions of Dr. Coan and Kendall.

The procedure was quoted as being about 6000 dollars more expensive (around 15 000 USD total) than the similar procedure quoted by the surgeon at my second consultation, but after a lengthy pros and cons discussion with my husband and therapist, it really made the most sense to go with the surgeon I felt the most comfortable with, and who I believed would listen to me and explain things thoroughly.

Once I selected Dr. Coan as my surgeon, I booked my surgery for May 5th. I was then given access to several videos and information packets about preparing for the surgery. Again, I was extremely grateful for the thoroughness of this information.

In these written and video packets, Dr. Coan provided detailed pre-operative instructions that are broken down into 3 or more weeks prior to surgery, 2-3 weeks prior to surgery, one week prior to surgery, day before surgery, and day of surgery. These sections clearly detail pre-operative diet recommendations, over-the-counter medications to buy, medications and supplements to avoid, and general instructions for pre-surgery preparations. Similarly, I was provided with detailed post-operative information and instructions that are broken down into day after, two weeks after, 6 weeks after, 3 months after, 6 months after, and one year after surgery. There were also several videos to watch about post-op constipation management, post-op nausea, and post-operative breast massage.

I cannot express how helpful the availability of this information has been. The only recommendation I would have for the team would be to create a specific bundle that combines breast augmentation and mastopexy, as there is so much overlap in the information for the two different procedures with only minor differences, and it was a bit like a "where's waldo" finding those differences. I assume many women combine these procedures, so this would be a useful consolidated packet for others.

Similar to my initial consultation, I was asked to email over any specific questions I may have so they could be reviewed ahead of time. I appreciate this step so much! The pre-op appointment was conducted by a nurse, and did have a lot of redundancy of information from the information packets. However, that makes sense to me, as I assume it is part of the team's due diligence to make sure the information has been adequately conveyed to the client.

Because I had read so much about capsular contracture, and that post-operative dental cleanings could result in infections that may lead to it, I decided to get my teeth cleaned on 04/13/2022 (3 weeks prior to my surgery date). Unfortunately, since this cleaning, I have had swollen gums on one side of my mouth, and I have been quite nervous about how this will impact my surgery, as the informed consent document very clearly states: " It is important to tell your surgeon of any other infections, such as a history of MRSA infections, an open wound, recent upper respiratory infection/ pneumonia, ingrown toenail, insect bite, tooth abscess, or urinary tract infection. Infections in other parts of the body, may lead to an infection in the operated area."

I told them about this worry in the pre-op meeting, but the nurse seemed to think it was okay. My advice here is to not do dental cleanings less than a month before your surgery date!! Skip the risk/worry/headache entirely.