Referred to as areolar herniation, tubular breasts, glandular hypoplasia, or tuberous breast deformity, many women with this condition do not know that this is a developmental problem. They think their breasts are simply asymmetric or they are self-conscious that they droop even if they are young or have small breasts. This can have a dramatic effect on confidence, appearance, and self-esteem.
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After doing a lot of research on a condition I had called Tuberous Breast Deformity I came across Dr. Killeen and Dr. Cassileth. They specialize in many different conditions of the breast. With Tuberous Breast Deformity, you have to be very careful that you go to a surgeon that is familiar with how to correct this problem or you could end up with a terrible result...
Tuberous breasts are narrow at the base of the breast (the part closest to the breast crease), with a large areola. This condition becomes noticeable in the early stages of breast development. With a normal breast, tissue extends outward from the areola as the breast matures; with tuberous breasts, the base is tight and this constriction forces the areola and breast outward. In tuberous breasts, the areolae are typically large and the breast shape is more tube-shaped or cone-shaped. The tight base constricts breast growth, which is why tuberous breast is also known as constricted breast. The cause and exact number of tuberous breast deformities is unknown, but some experts estimate that almost 50% of women who have breast augmentation actually have a mild to moderate form of this condition. 1
Tuberous breasts are often thought of as small and are traditionally corrected with breast augmentation surgery. At Cassileth Plastic Surgery in Beverly Hills, we recommend that the underlying shape of the breast be repaired, when necessary, whether breast implants are chosen in addition to the repair or not. A complete evaluation of the tuberous breast involves assessing inferior mammary crease position, which is typically closer to the nipple than usual, evaluating the degree of areolar herniation as there is typically an enlarged or bulging areola, assessing lack of outermost breast tissue, and measuring breast asymmetry. Women with tuberous breasts may have many or all of these characteristics, and additional surgical maneuvers are more corrective than augmentation alone. Our plastic surgeons are dedicated to providing patients with tuberous breasts with a personalized treatment plan that delivers natural-looking results.
Surgery to correct tuberous breasts is a customized procedure that may involve several different cosmetic and reconstructive surgery techniques. We will create your surgical plan to meet your unique needs and goals.
Your own natural fat is placed in areas where the breast never developed, rounding and filling out the breast shape. Fat is usually grafted as a "doughnut", supplementing the normal tissue. The fat is harvested from another area of the body using liposuction and then transferred through the breast's thinner tissue to improve contour.
Many tuberous breasts have too short a distance between the nipple and the inframammary fold, which is the crease under the breast. There may be too much tissue directly behind the nipple, but not enough at the bottom where the breast should be. The breast tissue can be "unrolled" for these patients, enabling the breast behind the nipple to unroll into a lower position— similar to unrolling a window shade. This can be done through an incision either at the nipple or at the new crease location, making the nipple less prominent and lowering the breast.
During traditional repair of tuberous breasts, silicone or saline breast implants are placed and the existing inframammary crease is "scored" or "released" to get rid of the dent where the old crease used to be. Our plastic surgeons find that this is often not enough, as there is thicker tissue above the old crease and thinner tissue below, and the dent is still evident, even after surgery. Unrolling or fat grafting helps to even out the tissue more than scoring.
Breast implants may be used, often in the subfascial position, to ensure they stay at the new inframammary crease position. With breast asymmetry, we usually perform a breast reduction (mastopexy) on the larger breast and then use the same implant size for better long-term symmetry. This technique can also minimize the chance of recurring asymmetry with breast aging and/or weight change.
Often, the larger breast, or both breasts, are reduced in size, and a breast lift can be performed at the same time if necessary. The reduction is not performed in a typical manner but instead focuses on removing extra tissue contributing to the tuberous shape.
In rare cases, tissue expansion may be used for correction of tubular breasts. This is typically recommended for patients who desire large breasts but have severe tubular breast deformity with very tight skin. In these cases, a tissue expander may be used to expand the breast tissue with an eventual swap for an implant a few months after.
You will have an initial consultation, where we will review your medical history and evaluate your specific breast shape and size and figure out how to get you to the shape and size you want to be. We often morph the outcome to visualize your likely results and finalize the size of any breast implants that will be used.
You will also have a complete preoperative visit in the office approximately two weeks before your surgery. During this visit, we will review your specific surgery and your recovery. Prescriptions for medications to be taken after surgery are reviewed. All blood thinners, including over-the-counter pills such as aspirin and Motrin, are stopped. Routine lab testing and any necessary breast imaging studies are ordered.
Tuberous breast surgery is typically an outpatient procedure performed with general anesthesia. We will focus on reshaping your breasts to look natural and symmetrical at your desired breast size. The surgical techniques used will vary from patient to patient, but we will discuss your treatment plan with you prior to surgery.
Recovery varies greatly depending on which combination of procedures is used. Generally speaking, the first week after surgery will require your full time and attention to taking care of yourself, limiting your activity, eating, and sleeping well. The second week after surgery, you usually return to normal day-to-day activities, but with limited exercise and lifting. At one month after surgery, you are released to regular activity. The final result is evaluated at a follow-up appointment six months after surgery.
If you are bothered by protruding nipples and asymmetrical, narrow breasts or if you have had droopy breasts (ptosis) since development, tuberous breast correction may be a solution for you. Ideal candidates are in good general health and non-smoking.
An experienced physician or breast surgeon can diagnose tuberous breasts with an exam. Tuberous breast abnormalities are classified into different types:
Type I: minor constriction of tissue in the lower breast
Type II: moderate constriction and deficiency of breast tissue in the lower breast
Type III: severe constriction and deficiency of breast tissue in the upper and lower breast
Most insurance plans do not cover tuberous breast correction surgery because they consider it a cosmetic surgery. Check with your insurance company to learn about your coverage.
Breast surgery will not have a negative effect on your ability to breastfeed but many women with tuberous breasts are not able to breastfeed because their glandular tissue did not develop properly during puberty.
When combined with other techniques, breast implants are a reliable way to achieve symmetry and a proportionate size. If you have a mild case of tuberous breast deformity, it may be possible to attain the results you want without implants. Talk to your surgeon during your consultation to learn more about which options may be best for you.
1 American Society of Plastic Surgeons. The Psychosocial Benefits of Plastic Surgery for Young Women With Congenital Breast Asymmetry. Available: https://www.plasticsurgery.org/news/press-releases/the-psychosocial-benefits-of-plastic-surgery-for-young-women-with-congenital-breast-asymmetry? Accessed July 22, 2021
2 Klinger M, Caviggioli F, Giannasi S, et al. The Prevalence of Tuberous/Constricted Breast Deformity in Population and in Breast Augmentation and Reduction Mammaplasty Patients. Aesthetic Plast Surg. 2016 Aug;40(4):492-6. doi: 10.1007/s00266-016-0650-9. Epub 2016 Jun 6.
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