Tuberous Specialist Plastic Surgeon
Dr Douglas McManamny is our Specialist Plastic Surgeon for Tuberous Breasts (also called Tubular Breasts) surgery. Dr McManamny operates at accredited major hospitals in Melbourne using only experienced anaesthetists and a top team of surgical support staff.
He is very caring and highly-experienced, and fully customises every procedure for each individual patient.
Do you have tuberous ‘tubular’ 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 specialist surgery.
Tuberous or ‘tubular’ breasts development and appearance
Some patients suffer from breasts that didn’t develop properly – small unevenly developed breasts with puffy nipples and occasionally other unusual complications like 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.
How do I know if I have Tuberous Breasts?
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.
Tuberous breasts are quite distinctive. 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.
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 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 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.
Solutions to correct Tuberous Breast Deformity
First of all, Dr McManamny starts with a thorough assessment of breast development, with a diagnosis of just what happened.
Most surgical solutions involve some form of glandular remodelling.
- 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 remodelling 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.
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.
*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 Tuberosity and Anatomical Implants for Tubular Breasts
If a patient only has a mild tuberosity and a reasonable amount of breast tissue a small anatomical implant in a single operation is often the best option. 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 cases an implant doesn’t work alone. 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 we also need to reshape the breast surgically to produce a pleasing result.
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.
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.
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 Specialist Plastic Surgeon Dr Douglas McManamny, who is renowned for tuberous breast correction surgical expertise.
Our approach to recovery is simple. We do whatever we can to get you back to your normal life as soon as possible.
Support for Interstate and Overseas Patients
Please visit our Interstate and Overseas Patients page to find out how we can help you.
NEXT STEPS on your Surgical Journey
How to Book your Initial Consultation
- Email us or Call on (03) 8849 1400 to arrange your surgeon consultation appointment.
- A Referral from your GP or from your Specialist is helpful but NOT essential – you can have a consultation without a GP Referral
- 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 1400 and ask for Michelle.