Tuberous Breast Correction

Tuberous breast deformity is a condition that affects many girls during puberty as breasts develop. This condition is characterised by a narrow or constricted base, enlarged areolas, breast asymmetry, and a high breast crease. This characteristic shape is often due to the underdevelopment and constriction of breast tissue, which can cause the breasts to appear elongated or conical rather than round or teardrop-shaped. From breast augmentation to areolar correction to fat grafting procedures, there are several options for correcting tuberous breasts.

What are Tuberous Breasts?

While every woman has slightly mismatched breasts, women with tuberous breasts are dealing with an obvious difference in the appearance of their breasts. Tuberous breast syndrome is a term that we use to describe several different issues.

Low-positioned breasts, enlarged areolas, herniation of breast tissue through the nipple, malformation of the breast base, and other problems are all part of what it means to have tuberous breasts.

Women with tuberous breasts typically notice the issue during puberty. As their breasts develop, the difference between their breasts’ size and shape becomes clearer. Not all breasts are born equal. Every woman has a certain level of uniqueness in her breasts’ shape and size. However, if your breasts are remarkably small, narrow, cone-shaped, widely spaced, and asymmetric, they may be tuberous. Tuberous breasts are also often accompanied by large areolas (pigmented skin around the nipple) and nipples that point downward.

Features of Tuberous Breasts

  • A narrow or constricted base
  • A gap of 1.5 inches or more between the breasts
  • A high breast crease
  • Enlarged areolas
  • Noticeable breast asymmetry (one is obviously larger than the other)

If you suspect that you might have tuberous breasts, you can have them properly assessed by a qualified plastic surgeon. You should choose a certified plastic surgeon who is familiar with diagnosing and treating tubular breasts and not just any surgeon.

What Causes Tuberous Breasts?

Tuberous breast deformity happens when your breasts fail to properly develop during puberty. It can affect one or both breasts. It’s still not very clear what causes tuberous breasts.

Some doctors believe that it’s congenital; the result of an unknown event that occurs during fetal development. The result of this event, however, will only become evident during puberty as the breasts develop.

Regardless of the initiating factor, tuberous breasts fail to develop enough tissue. In many cases, the tissue ring that surrounds the nipple also fails to properly develop.

Types of Tuberous Breasts – Three Grades – What are the different degrees of tubular breasts?

Dr Turner first assesses the type or grade of tuberous breasts before suggesting treatment options.

Tubular breasts are classified into three types based on their severity:

  • Grade I: This is the least severe type. If breasts lack tissue in the lower and middle regions, then it may indicate type I tuberous breasts. This is the most common type, giving breasts a “smaller than average” appearance.
  • Grade II: There is more tissue deficiency in this type than in type I. The entire lower half of the breast is affected. The areola in type II tuberous breasts is usually enlarged, stretched, and pointed downwards.
  • Grade III: This is the most severe type. In this case, the breast growth is constricted in all four quadrants of the breast; the entire breast is severely affected. The areolar tissue is stretched thin and weak. This type may affect breastfeeding ability.

Traditional Techniques to Treat Tuberous Breasts

Tuberous breast asymmetry has traditionally been treated by the combination of a breast lift procedure to reshape the breast and breast augmentation surgery to increase breast volume.

The most common breast lift procedure used is a periareolar (Benelli) breast lift technique. In this procedure, there is an incision around the areola. It lifts and reduces the size of the areola so that it’s centered over the breast mound. This also reduces herniated breast tissue.

In the majority of women undergoing tuberous breast asymmetry correction, a breast augmentation is performed. Not only does the breast implant increase the overall breast volume, but it widens a constricted breast and adds volume to the lower pole of the breast.

To allow the breast implant to expand, a plastic surgeon will often perform glandular scoring cutting to release the internal contractures to allow the breast implant to expand the breast shape.

Dr Turner has THREE Different Surgery Options for Tubular Breasts

Tubular breasts can only be treated with corrective surgery. This can be achieved either by traditional surgical reconstruction (with or without implants) or by fat grafting.

1. Traditional Surgical Correction for Tuberous Breasts

Traditional correction of tuberous breasts usually involves surgical tissue remodeling (similar to a breast lift) with or without breast implants. It is usually done using a periareolar (around the nipple) incision.

Tuberous breast reconstruction usually involves:

  • The release of the constricted tissue around the base of the breast to round it out (a process known as glandular scoring).
  • Spreading out some of the breast’s tissue into the lower part where it’s lacking.
  • Reshaping of the inframammary fold to create a clear lower breast slope.
  • A breast lift to reposition the nipple at a more proportional level.
  • A reduction in the size of the areolas in case they are enlarged.
  • Decreasing the gap between the breasts.

If native breast tissue is insufficient to achieve satisfactory results, breast implants may also be necessary. This may require two separate surgeries in some cases.  This can be combined as one procedure in the grade I type tuberous breast – but those with grade II and III often require a staged procedure over 9-12 months. The use of a breast tissue expander is only for severe grade III tuberosity.

  • During the first surgery, Dr Turner implants tissue expanders (temporary inflatable implants),
  • The expanders stretch out your chest muscles and skin making room for future implants.
  • They will be kept in place for several weeks or months and will be regularly inflated by Dr Turner.
  • Once your breasts are large enough, you will receive a final corrective surgery, and the expanders will be replaced by definite implants.

In most cases, breast implants alone are not enough, and surgical remodeling (lifting) is done to achieve satisfactory results.

2. Fat Grafting for Tuberous Breasts

Fat grafting is indicated for women who want to fix their tuberous breasts without implants. During this procedure, Dr Turner removes excess fat from one region of your body (e.g. hips, belly, thighs, etc.) by liposuction and injects it into your breasts. This allows him to strategically inflate your breasts and remodel them. Moreover, the injection of the fat beneath the skin loosens up the constricted tissue.

Can Fat Grafting Help Tuberous Breasts?

Fat grafting or Fat Transfer is the process of taking fat from another part of the body and moving it to another area. This fat transfer increases breast volume. Fat grafting lets you gain one cup size without a breast implant. A fat transfer procedure can be done in conjunction with breast implants as well. The process of doing fat grafting with breast implants is called composite breast augmentation or lipoimplant.

To get an in-depth view of breast asymmetry and fat grafting, check out our page on tuberous breast asymmetry.

3. Hybrid Breast Augmentation – Implant combined with Fat Grafting

Fat grafting does not necessarily have to be done alone. It can be combined with breast implants to customise the size and shape of the breasts further. This is called a hybrid augmentation or composite breast augmentation” or “lipo-implant” and it offers the advantages of both fat grafting and breast implants together:

  • More achievable volume
  • More strategic contouring
  • Less implant visibility
  • More pronounced cleavage

Limitations of Traditional Techniques for Tuberous Breasts

Using breast implants alone to address tuberous breasts may not adequately address the lower and outer aspects of the breast area. These spots are covered by thin skin with no underlying breast tissue like a normal breast, which means that breast implants are much more visible when used in these spots.

In the visible cleavage area, the breast implant can be placed under the chest muscle to minimise the visibility of the edge of the breast implant. However, this often limits the expansion of the medial breast and results in a wide cleavage. The placement under the muscle can also cause a permanent crease on the lower aspect of the breast if the natural breast isn’t fully expanded by the implant.

Another issue with traditional techniques is the use of glandular scoring. While it is a standard part of breast implants, it is a painful process that requires considerable recovery time. There is an increased risk of nerve damage to the nipple with a potential for sensation loss as well as bleeding and haematoma.

Recovery after Tuberous Breast Correction Surgery – What to expect during recovery from surgery

Here’s what you need to expect during recovery from tuberous breast reconstruction:

  • Swelling will last up to four weeks after the surgery.
  • Some pain and discomfort are expected but they can be addressed by taking the prescribed medications.
  • Get at least 1 week of home rest with no work and minimal physical effort.
  • You can generally get back to exercising within 3-4 weeks after the surgery.
  • Intense cardiovascular activity should be avoided for 12 weeks.
  • You might be asked to wear a push-up (surgical) bra for a month after surgery.
  • You should sleep on your back for a month after surgery.

The final results need around 1-2 months to settle in. By that time, the swelling and bruising will be gone. The breast scars will mature over the following months, making them less noticeable.

Risks and Complications of Tuberous Breast Surgery

Like any surgery, tuberous breast surgery has risks and complications, such as:

  • Anaesthesia risks
  • Asymmetry recurrence
  • Bleeding
  • Breast shape or size discrepancies
  • Changes in nipple sensation
  • Dissatisfaction with results
  • Fluid accumulation
  • Implant-related complications (if implants are used)
  • Infection
  • Scarring