What are Tuberous Breasts?
Tuberous breast anomaly, also known as tuberous (tubular) breast deformity, is a congenital condition that affects the development of the breast, often first becoming apparent during puberty when the breasts fail to develop symmetrically.
The cause or aetiology for tuberous breast anomaly is still not fully understood:
- Developmental anomaly: Tuberous breast deformity is thought to occur during fetal development of the breast in pregnancy. However, it does not become noticeable until puberty when the breasts begin to develop.
- Connective tissue defect: The deformity is believed to arise from abnormal connective tissue forms tight bands or rings around the base of the breast, preventing normal expansion of the breast tissue during development.
- Restricted breast growth: The breast tissue is restricted from growing evenly in all directions. This causes the breast to take on a tubular or elongated shape rather than a more typical rounded shape.
- Genetic predisposition: While no specific genes have been identified as the cause of tuberous breast deformity, it is thought to have a genetic component as the condition is known to runs in families.
Tubular breasts are classified into three types based on their severity:
01.
Grade I
There is deficient breast tissue in the inferior and medial aspects of the breasts. This is the most common type of tuberous breast and often under diagnosed as the breast often looks small with a short or tight lower pole of the breast.
02.
Grade II
There is more global deficiency in the breast tissue affecting predominantly the lower half of the breast with a tight or constricted fold sitting much higher than the normal inframammary fold. The areolar is often stretched, pointing downwards creating the appearance of breast ptosis.
03.
Grade III
The entire breast is severely affected with the remaining breast tissue often herniating through the stretched and weakened areola tissue. This is the most difficult type to correct, often requiring a multistage approach to create the desired breast shape.
Suitable Candidates for Tuberous Breast Correction?
Suitable candidates for breast asymmetry correction should meet the following criteria:
- Physical Health: Be in good overall health with no underlying medical conditions that could interfere with the wound healing process.
- Emotional Well-being: Have realistic expectations and a positive mindset regarding the outcomes of breast implant surgery. As of 1st of July 2023, patients are required to have a psychological evaluation to ensure they are suitable to proceed with surgery.
- Stable Weight: It is recommended to be near your target weight before undergoing the procedure, as weight fluctuations can affect the cosmetic results.
- Non-smoker: Smoking or vaping dramatically interferes with the healing process and increases the risk of complications. Therefore, candidates are required to cease smoking for a minimum 6 weeks before and after the surgery.
Breast asymmetry correction can help address these concerns.
- Improve Shape: The release of constricted tissue around the base of the breast and lowering a high, constricted inframammary fold using breast implants and fat grafting can correct the breast shape asymmetry.
- Improve Symmetry: Often there is moderate volume asymmetry in tuberous breast deformity that require a combination of asymmetrical breast implants, fat grafting and/or breast lift procedures to correct the breast volume asymmetry.
- Improve Areolar: The reduction in the size and flattening of the puffy or herniated areolar nipple complex is an important aspect in correction of tuberous breast deformity.
- Improve Cleavage: Decreasing the wide gap between the breasts by the addition of breast implants and fat grafting can create fuller breast cleavage.
How is Tuberous Breast Correction Performed?
Tuberous breast correction is always performed under general anaesthesia in a fully accredited hospital with the assistance of a qualified anaesthetist. Depending on the grade of the breast asymmetry, it may take 1 to 3 hours and require multiple surgeries staged over one year.
While simplistically breast asymmetry can be corrected by either making the larger breast smaller, or the smaller breast larger, this is often not sufficient to correct the shape of the tubular breasts. There are several important considerations to be made during the planning of your tuberous breast correction surgery with Dr Scott J Turner, Specialist Plastic Surgeon.
01.
Breast Augmentation
While a breast implant can be placed on the smaller size breast to add breast volume and correct symmetry. In most cases, Dr Turner will perform a breast augmentation on both sides to assist with widening the constricted breast base and narrowing the gap between the breasts to create cleavage. While traditionally different size implants were used to correct volume asymmetry, now it is preferred to use similar size width implants and to correct volume asymmetry by addition of fat grafting and a breast lift.
02.
Breast lift
In patients with breast asymmetry, the larger breast has a lower-positioned nipple areolar complex, requiring a breast lift to improve symmetry. More commonly in patients with tuberous breasts, both breasts have a low nipple areolar complex position with some degree of areolar herniation, requiring a breast lift on both sides in combination with a breast implant and fat grafting.
03.
Areolar Reconstruction
Areolar reconstruction in tuberous breast correction focuses on reducing the size of the enlarged areola, correcting herniation of breast tissue, and repositioning the nipple-areola complex to a more elevated position by a periareolar or Benelli breast lift. Dr Turner often recommends that the areolar reconstruction is delayed 6 – 12 months after the breast shaping procedure to give the best outcome.
04.
Breast Gland Modification
Traditionally in tuberous breast deformity, the constricted breast tissue at the base and lower aspect of the breast was modified by glandular scoring technique. This involves several cuts to the breast gland to release internal bands or contractures allowing it to expand over the breast implant. One of the concerns of this technique is the risk of nerve damage and sensory loss the nipple and increased risk of bleeding. This has largely been replaced in modern breast asymmetry correction with fat grafting to the breast.
05.
Fat Grafting
Dr Turner can expand the deficient aspects of the breast tissue selectively by using your body’s own fat tissue and reinjecting it into the breast as part of the tuberous breast correction. Fat grafting during this procedure, Dr Turner removes excess fat from one region of the body (e.g. hips, belly, thighs, etc.) using liposuction. The fat is then purified and reinjected into the breasts to add volume. The injection of the fat beneath the skin loosens up the constricted tissue and improves the ability of the breast implant to expand the constricted breast base.
Recovery after Tuberous Breast Correction
Recovering from a breast asymmetry correction involves several stages and requires careful attention to the post-operative instructions provided by Dr Turner to ensure the best results.
- Rest & Elevation: Rest is crucial. It is important for the first 2 weeks after your procedure to keeping your head and back elevated on a few pillows while sleeping. Most patients can sleep on their sides after 3 weeks comfortably.
- Post-Operative Dressings: The sutures for all breast incisions are self-dissolving, eliminating the need for suture removal. Specialised dressings will be applied to support the wound during the first week, this will be changed by Dr Turner at your follow up appointment.
- Cold Compresses: Bruising, swelling and discomfort in your breast region is expected, especially with breast implants placed in a subpectoral placement. The use of cold compress to your cleavage area in the first few days is a simple and effective measure to assist your healing.
- Compression Garments: You will be provided a surgical compression bra to wear full time for the first month post-surgery. This assists with settling of the breast shape and assists with postoperative breast discomfort. After this time, Dr Turner recommends sleeping in the surgical garment at night for 6 months and wearing a supportive sports bra during the day.
- Incision Care: Scar management is an important part of any plastic surgery procedure. Scars on breast naturally will mature over 3 years before they look their best. During this time, we recommend a protocol of scar management, which includes silicone scar therapy and laser treatments.
- Medications: The anaesthetist will provide you with antibiotics and prescription pain medication that you can take at home over the first week.
- Normal Activities & Exercise: Most women can gradually return to normal activities over the first 2 weeks. However, more high intensity exercise needs to be avoided in the first 6 weeks, with strong upper body / chest exercise should be avoided for 3 months.
- Follow Up Appointments: Dr Turner recommends frequent follow up during the first 1 year after breast asymmetry correction. It is highly advisable that these reviews are in person at our Sydney clinic at 1 week, 1 month, 3 months, 6 months and 1 year.
Risks and Complications of Tuberous Breast Correction
As with any surgery, it is important that you are fully informed of the potential risks associated with breast asymmetry correction. While all care is taken to minimize these complications, they may and do occur despite the best medical care.
It is important that you carefully read and understand the potential risks and they will be discussed in further detail when you have your consultation with Dr Turner.
- Scarring: Visible scarring is common, though it typically fades over time. In some cases, scars may remain more prominent or raised (hypertrophic scars or keloids).
- Infection: Infections can occur at the incision sites or around a breast implant, which may require antibiotic treatment or, in rare cases, additional surgery.
- Sensation: Some patients may experience a loss of sensation in the nipples or breasts. This may be temporary or permanent.
- Asymmetry: Breast size, shape, or nipple position may differ slightly after surgery. Revision surgery may be required to correct significant asymmetry.
- Delayed Wound Healing: Delayed wound healing can happen, especially along incision lines. This is more likely in smokers (vaping) or individuals with certain health conditions (e.g., diabetes).
- Breastfeeding Issues: In some cases, the ability to breastfeed may be affected, especially if significant tissue is removed. Some people can breastfeed after the surgery, but it’s not guaranteed.
- Nipple Necrosis: Rarely, the blood supply to the nipple can be affected, leading to necrosis (tissue death).
- Blood Clots: There is a risk of blood clots, particularly in the legs (deep vein thrombosis) or lungs (pulmonary embolism), after surgery.
- Bleeding or Hematoma: Some patients may experience excessive bleeding during or after surgery, leading to the formation of a hematoma (a collection of blood under the skin). In rare cases, this may require additional surgery.
- Fat Necrosis: In rare instances, fat tissue in the breast may die and form firm lumps.
- Capsular Contracture: This occurs when scar tissue forms around the implant, distorting the breast shape. Additional surgery may be required to address this complication.
- Implant Rupture or Leakage: Implants can rupture or leak over time, which may necessitate removal or replacement of the implant.
- Seroma: Seroma is a collection of fluid that forms around the implant, causing swelling, pain, and discomfort.
- Anaesthesia Risks: General anaesthesia carries its own set of potential risks, such as adverse reactions or complications.
- Unsatisfactory Results: Despite the best efforts of the surgeon, breast reduction surgery may not result in the patient’s desired outcome.
