Tuberous Breast Surgery | Melbourne

Tuberous Breast Surgery – Overview

  • Tuberous breasts are a specific type of breast shape that appears pointed, narrow or puffy in nature. Tuberous breasts tend to lack the more rounded or teardrop shapes of breasts that the majority of women develop post-puberty.
  • The base of the breast(s) may be constricted or narrow.
  • The nipples are usually out of proportion with the minimal glandular breast tissues and the appearance of the nipples and small breast mound may appear ‘droopy’ or ‘snoopy’ like in shape or appearance.

Many women with tuberous breasts are looking for the best Plastic Surgeon to give them advice on their corrective surgery options.  To find the best surgeon, read our TIPS for finding the Best Plastic Surgeon(s) in Melbourne blog and be sure you recognise that NOT all surgeons who perform breast augmentation surgery are actually a Plastic Surgeon.

Tuberous Breast Surgery – Definitions, Types and Treatments

Tuberous Breast Plastic Surgery – OVERVIEW

Overview of Breast Augmentation in the Tuberous Breast Patient

  • Tuberous or tubular breasts appear narrow and/or constricted in nature.
  • Complex, customised breast augmentation surgery using breast implants may be required as a long-term treatment option but re-operation is expected as implants are not life-long prosthetics.
  • Advanced placement techniques and breast crease adjustments are often needed to give patients with tuberous breast a more aesthetic breast appearance such as a more rounded, teardrop or naturally-balanced chest appearance if this is desired by the patient.

Diagnosis of Tuberous Breasts

There are four classifications of tuberous breasts although some Surgeons use a 3-classification system.  Treatment: Surgical corrections such as a breast augmentation, asymmetry correction and/or surgical IMF adjustment.

Tuberous Breast Deformities – Classifications (4 Types)

  1. Type I (hypoplasia of the lower medial quadrant)
  2. Type II (hypoplasia of the lower medial and lateral quadrants, sufficient skin in the subareolar region)
  3. Type III (hypoplasia of the lower medial and lateral quadrants, deficiency of skin in the subareolar region)
  4. Type IV (severe breast constriction, minimal breast base).

Source: https://www.ncbi.nlm.nih.gov/pubmed/8881778

  • Dr Sackelariou MBBS FRACS (Plas) and Dr McManamny MBBS FRACS (Plas) are some of our team’s experts for corrective breast surgery including for Tuberous Breasts (also called Tubular Breasts) or removal and replacement of breast implants.

What HOSPITALS do your Surgeons operate in for tuberous breasts?

  • Our Tuberous Breast Surgeons operate at accredited major hospitals in Melbourne using only experienced anaesthetists and a top team of surgical support staff.
  • Our Surgeons are often highly recommended for tuberous breast surgery, because in addition to being experts at getting good results (results always vary from patient to patient, however), they are also very caring and easy to talk to.
  • Plus, they insist on full customisation of every breast surgery procedure to suit the individual patients needs, so you know you’ll be getting a body-customised surgical approach to suit your overall frame AS WELL AS your breast area and your tuberous breast concerns.

Find out more about Tubular breasts surgery options. Phone today on 0388491444 to arrange a consultation or ask preliminary questions.

What do tuberous ‘tubular’ breasts look like?

How to tell if you have potentially tuberous breasts:

  • Have your breasts not developed properly?
  • Do you have “puffy” nipples?
  • Do you have small, unevenly developed breasts?
  • Do you have triangular-shaped and droopy breasts?
  • Are your nipples pointing downwards or inwards?

You may have tuberous breasts which can be corrected with Plastic Surgery (Corrective Breast Augmentation).

Brief Summary of Types of Tuberose Breast Development and Identification by Dr Kolker (NY).

Article (Source): https://www.ncbi.nlm.nih.gov/pubmed/25539297

TYPEBaseBreast lower foldBreast glandular volumeDegree of breast droopingSkin envelopeAreola size
Type IMinor constrictionMinor elevation medially (inner part of breast)Minimal to no deficiency in the lower medial breast quadrantMild to severeSufficientEnlarged
Type IIModerate constrictionElevation on medial and lateral (outer part of breasts) sidesModerate deficiency in both lower breast quadrantsNone or mildInsufficient in the lower partMay be normal or have mild-moderate herniation
Type IIISevere constrictionElevation of entire fold or fold absenceSevere deficiency in all four breast quadrantsMild to moderateInsufficient overallSevere herniation

 

Example of Tuberous or ‘tubular’ breasts: Tubular development and appearance

Before and After Corrective Surgery Photos - Treatment for Tuberous Breasts
Before and After Images: Corrective Surgery for Tuberous Breasts by Melbourne Surgeon Douglas McManamny

Some patients suffer from breasts that didn’t develop as normally expected – they may appear to be small, unevenly developed breasts with puffy-looking nipples and occasionally other unusual complications like moderate or severe breast asymmetry.

If your breasts developed so that they didn’t look quite right, or there is a large difference in their appearance, there is the possibility that the problem is one known as tuberous breasts.

Patients come to see specialist plastic surgeon Dr Douglas McManamny with a range of concerns about the appearance of their breasts, varying from ‘both my breasts are quite small and my nipples are puffy’ through to ‘my breasts look different, one is almost normal and the other is droopy and the nipple points down and in’.

Tuberous breasts is a medical term used to describe a whole range of breast appearances that occur as a woman’s breasts are developing. Sometimes other terms are used, for example ‘tubular breasts’ or ‘constricted breasts’.

Usually as breasts develop during puberty there is an even expansion of breast tissue above and below the level of the nipple. This produces an even rounded shape to the breasts, and even if they do not look perfectly symmetrical they will look similar.

Photographs of Tuberous Breasts and Surgery Results

Tuberous Breasts - Corrective Surgery (Before & After Photos) - Dr Doug McManamny
Tuberous Breasts – Corrective Surgery (Before & After Photos) – Dr Doug McManamny

Tuberous breasts are quite distinctive from other types of less-developed, smaller breasts.

  • We have known that tuberous breasts tend to run in families for a long time, and recently it has become apparent that tuberous breasts are probably a distinct genetic variation.
  • The degree of tuberousity (tuberosity) varies from patient to patient and often between breasts as well.
  • Women with small tuberous breasts often have a very small amount of breast tissue below a large puffy nipple.

Gauging Tuberose Breast Development

  • Visually, tuberous breasts have a characteristic narrow profile when viewed from the side.
  • Tuberous breasts vary in size but tend to be smaller and have a wide space between them.
  • Importantly, tuberous breast have a flattened connection with the chest wall.

A normal breast joins to the chest wall with an almost round or circular base.

The flattening of the base of the breast where it joins the chest wall in TUBEROUS BREAST conditions is sometimes described as a constricted base.

Sometimes tuberous breasts are also referred to as constricted breasts. Its best to try not to use the terms interchangeably because not all breasts that have a constricted profile at the chest wall are truly tuberous.

Tuberous or tubular breasts are quite rare in the community, but something we see very often in our clinic. They certainly can be operated on, and in most cases the results are a great improvement.

What causes Tuberous Breasts?

We do not know exactly why tuberous breasts develop, but we do know the changes that occur that produce the appearance of tuberous breasts.

  • Breasts develop in an envelope of fascia or fibrous tissue between chest skin and the underlying muscles (mainly the Pectoralis Major muscle).
  • If that fascia is excessively tight, it will restrict the development of the base of the breast, especially in the lower part which makes the breast look quite narrow, and has the lower border of the breast sitting quite high.
  • The fascia is weak just beneath the areola and nipple. The combination of a strong fascia around the margins of the developing breast and a weak fascia centrally pushes the breast tissue into a small area behind the nipple. This stretches the areola and can make it look puffy as well.
  • In many cases the breast can be underdeveloped and remain small.
  • Tuberous breast changes can be similar on each side, or can be different.

Surgical Treatments or Solutions to correct for Tuberous Breast Deformity or Tubular Breast Appearance

First of all, Dr McManamny and our other Breast Surgery experts start with a thorough assessment of breast development, to confirm or make a diagnosis of tuberose breast development.

Most surgical solutions involve some form of glandular remodeling.

  • This may take the form of internal ‘scoring’ to weaken the tight fascia around the base of the breast, or an unfolding technique to spread out the breast tissue into the lower pole (the part below the nipple level) of the breast.
  • If the nipple is not located at a satisfactory level, a Breast Lift may be performed.
  • If the areola is quite large, it can be reduced in size as part of the procedure, or by itself if no lift is required.
  • Depending on the amount of lift required, the operation may leave a scar only around the areola, or if a greater lift is required, there may be a vertical scar as well (a ‘lollipop’ scar).
  • If the breast hasn’t fully developed, an Augmentation with a Breast Implant can be considered, and this can be done at the same time as glandular remodeling and lifting, if necessary.

Because tuberous breasts are often different on each side, we commonly perform different operations on the right and left breasts.

The aim of surgery is for our patients to recover from their operation with breasts that look normal, are similar to each other and are balanced in size and proportion, with minimal obvious scarring.


Two Surgical Approaches to Tuberous Breasts

Correcting Tuberous Breasts with an Implant and Specialist Surgery

Some women with mildly tuberous breasts are happy with the shape of their breasts, but are seeking a larger size. Others, especially if they have very small or very tuberous breasts want a different shape and spacing as well.

  • It is quite important that even mildly tuberous breasts are treated differently to other breast types, attempting a simple breast augmentation on a tuberous breast risks a very poor result.
  • If an inappropriate implant is placed in the typical way the result can best be described as the existing tuberous breast distorted and sitting on a mound of implant.
  • Its very distressing for patients and the result of less trained and experienced surgeons simply not knowing what to do.  

Cost and Price of Tuberous Breast Surgery

Quotes are available during a consultation with a Plastic Surgeon.  The procedure is highly complex and you will want to understand the procedure theatre time, procedure, healing and recovery period and surgery risks.

Results will vary from patient to patient and your existing physique may present challenges or limitations to what can be achieved during surgery, so DO keep your expectations realistic AND discuss your goals and possibilities with your surgeon.

Correcting tuberous breasts is challenging but with care and the right surgical planning it possible to get excellent results. Tuberous breasts are very variable and to a certain extent that dictates what is possible. The exact surgical technique varies a great deal depending on the patient. Often because of asymmetry surgeons will take different approaches to each breast.  

General Breast Surgery Risks –


*Disclaimer: Individual results can vary significantly from patient to patient.
The information we provide is of a general nature. To find out what to expect for your preferred procedures, arrange to see one of our Specialist Plastic Surgeons for a full-history and surgical consultation. Read more about surgical outcome variability on our Disclaimer Page.


Mild Tuberousity and Anatomical Implants for Tubular Breasts

If a patient only has a mild-type tuberous breasts and a reasonable amount of breast tissue, then a small implant in a single operation may be a good solution. The procedure is a little different to a normal Breast Augmentation because the surgeon is trying to lower and reshape the fold beneath the breast (infra-mammary fold) to correct the shape of connection to the chest. It is also important to lessen the gap between the breasts as much as possible by increasing the infra-mammary fold toward the centre line of the chest.

In more pronounced or severe tuberose breast development cases, a breast implant doesn’t work on its own.

  • The breast tissue envelope near the nipple isn’t wide enough to fit a breast implant.
  • No matter how the pocket is cut, the fold moved or the implant placed the result is unsatisfactory.
  • In more pronounced cases of tuberosity, your Surgeon also needs to reshape the breast surgically to produce a pleasing result, not simply adding projection volume to the existing structures.  

By adding an implant that is a little wider than the existing breast and carefully shaping the pocket while lowering and reshaping the infra-mammary crease it is possible to insert an implant that  helps create a visually pleasing rounded breast. With some reshaping the existing breast tissue is moved to compliment the new rounded breast. Next we trim any excess skin or tissue and create a new skin envelope for the breast. In many cases as part of the reshaping we also move the nipple.


The NAC – Nipple Aerola Complex Surgery

It is important to choose a surgeon with extensive experience in complex breast procedures. Some patients can have a loss of nipple sensation and an impact on breast feeding depending partially on how the surgery is planned. In most cases loss of sensation is minimal. Sometimes a woman’s anatomy makes it very difficult to get a good aesthetic outcome and protect the nipple. The nature of tuberous breast makes it difficult to predict without examining a particular patient; your surgeon will discuss expectations and potential outcomes during your initial consultation..

Women with tuberous breasts do sometimes have issues breast feeding even without surgery, but many women do also successfully breast feed after surgery. For women who are seeking a significant size increase it often best to wait a little while after the initial surgery and then move to larger after the breast tissue has stretched and grown. This procedure takes longer and is much more technically demanding than a simple breast augmentation.


Correcting Tuberous Breasts using Breast Tissue Expanders and Specialist Surgery

For women with very small tuberous breasts there is another issue. All breast implants need an adequate cover of tissue like skin and superficial fat to cover them. If that layer is too thin the skin above the implant tends to be fragile and slow to heal. Problems like stretch marks, visible implant edges and rippling also become much more likely. The amount and shape of skin and underlying tissue on the chest partially dictates how large and what shape implant is possible.  

A very small amount of breast tissue dictates a very small implant. For women with small tuberous breasts, tissue expanders can allow a larger implant and reduce the amount of reshaping required during the main surgery. There are surgical and non-surgical expanders available. In the past expanders were widely used to help correct tuberous breasts, but the introduction of low profile anatomical implants has reduced their use.  

Using expanders is a great tool to deal with patients who want larger breasts but have only a very small amount of tissue to cover implants. They act to very gently stretch the skin and tissue of the chest. Over time the body will increase to amount of tissue around the expanders so that there is no more tension.


Breast Expanders

Surgical expanders are a small temporary breast implant that stretch and expand the skin and outer breast tissue to allow a larger implant later on. Placement of a surgical expander will depend greatly on a patients individual circumstances. In general the surgeon will place them in a slightly different position to surgical implants. Surgical expanders can be fixed size or gradually increased in size using saline. The time they stay in place will vary but is usually at a few months. When they are removed they leave an expanded envelope of skin and tissue to cover a permanent implant.

Non-surgical expanders are also available and use a vacuum pump to suck the breast out in a breast shaped cup. Generally they are left on for part of the day or overnight. If used regularly for several months they can add a useful amount of skin. Patient experiences with the system are generally pretty good. They are a little inconvenient but certainly less intrusive than surgical expanders. Non-surgical expanders do have their limitations though and in many cases the small increase they offer for skin and tissue isn’t enough.


Tuberous or Tubular Breast Surgery

Do you have concerns about the tubular appearance of your breasts? Contact us to arrange an appointment with one of our TUBEROUS breast surgery experts, such as Specialist Plastic Surgeon Dr Sackelariou or Dr McManamny, both renowned for tuberous breast correction surgery.

Our approach to recovery is simple. We do whatever we can to get you back to your normal life as soon as possible.

Phone us for detailed information about consultations and how to attain an evaluation of your suitability for corrective surgery for tuberous and/or asymmetrical breasts.


Further Reading (More articles and links to Medical Journal references at the end of this Plastic Surgery news article):

 2015 Jan;135(1):73-86. doi: 10.1097/PRS.0000000000000823.

Tuberous breast deformity: classification and treatment strategy for improving consistency in aesthetic correction.

Accessed online on 29 Oct 2018.

Tuberous Breasts – An Overview of Presentations & Different Types

Tuberous breasts often involve:

  • Constriction around the base of the breast (around the crease)
  • Large, puffy looking nipples
  • Minimal breast mound tissue other than the puffy-looking nipple aerola complex (ANC) – constricted breasts
  • Sagging, tubular-looking breasts that are small or narrow in nature (they might look ‘square’ or ‘pointy’ and the height of the breasts will not seem quite in balance, proportion wise).
  • Higher than normal breast crease (inframammary fold)

In more medical terms, if you have Tuberous Breasts then your Surgeon might note you have:

  • Herniated nipple aerola complex (NAC)
  • Lower Pole Hyperplasia
  • Deficient skin envelope inferiorly
  • Elevated Inframammary fold

There are different types of Tuberous breasts – and a classification system by Groulleu and colleagues that Surgeons can use to indicate the form of tubular breasts.

  • Type 1: Lower Medial Quadrant Deficient
  • Type II:  Both lower quadrants deficient
  • Type III: All four quadrants deficient with constriction of breast tissue horizontally and vertically

Source: Groulleau System Tuberous Breasts from DeLuca-Pytell, R.C. Piazza et al.

So if you think you might have TUBEROUS breasts and want an opinion from a genuine Specialist Plastic, Cosmetic & Reconstructive Surgeon, send an enquiry form (below) or phone us on (03) 8849 1444 during Clinic Hours. We’ll help you ascertain which of our Breast Surgeons can assist you with evaluating the condition and exploring your options for breast augmentation using quality breast implants and/or autologous fat transfer methods (if suitable).


How to Book your Initial Consultation for Tuberous Breast Surgery advice

  • Email us or Call on (03)88491444 to arrange your surgeon consultation appointment.
  • Browse the Recovery & Surgery GUIDE books to surgery and/or the Before and After Tuberous Breast Surgery – Augmentation Photos.
  • A Referral from your GP or from your Specialist is helpful – you can have a consultation without a GP Referral but if your tuberous breast condition is medically indicated for corrective surgery, and you have insurance coverage, a GP referral is a must in order to be eligible (not all patients will be eligible and strict criteria apply).
  • Schedule a confidential consultation with your selected Specialist Surgeon by paying the $200 booking fee.

What to Bring to your Surgeon Consultation

  • Bring a friend or relative to help discuss the information and your choices
  • Take lots of notes and read the documents provided thoroughly

Want more information before scheduling your Surgeon consultation?

  • Request more information about the procedure – call or contact us
  • Book a Complimentary Nurse Consultation (FREE)
  • Organise a phone call with Patient Coordinator (FREE)
  • Attend our Regular Practice Events and hear from our of Plastic Surgeons   and their top support team (FREE)
  • Organise a Skype call consultation with a Surgeon (available for Interstate patients)
  • Speak with a past patient that has had the procedure – call or contact us
  • Browse our Frequently Asked Questions including including how to choose a Surgeon for your procedure

Please contact us using this form to arrange to book a consultation or to speak with our Patient Care Coordinator. Send an enquiry form today or phone (03) 8849 1444 .

melbournes-experts-for-surgery

Further reading on Tuberous Breast Development, Causes and Surgical Treatments


Publications/Articles/sources:
 2015 Jan;135(1):73-86. doi: 10.1097/PRS.0000000000000823.

Tuberous breast deformity: classification and treatment strategy for improving consistency in aesthetic correction.

Source:  https://www.ncbi.nlm.nih.gov/pubmed/25539297 accessed online 29 Oct 2018.

Source: https://www.ncbi.nlm.nih.gov/pubmed/11149766 – accessed online 29 Oct 2018.
Source: https://www.ncbi.nlm.nih.gov/pubmed/7817890 – accessed online 29 Oct 2018.