ARE MY BREASTS TUBEROUS?
Any Plastic Surgeon who does a fair amount of Breast Surgery will inevitably field this question from patients. In fact, I see it posted all the time by patients on Plastic Surgery platforms like Real Self. A ‘Tuberous’ breast is a descriptor used to describe breasts that have unique anatomical features. While Tuberous Breasts can vary widely in appearance based on how severe their features are, there are underlying characteristics they all share. So let's break down exactly what a Tuberous Breast looks like.
Anatomy of a Tuberous Breast:
Tuberous Breasts tend to be smaller since the breast gland itself is constricted and sits directly behind the nipple and areola. Because of the position of the gland, it bulges through the areola, effectively enlarging the areolar diameter. In a non-tuberous breast, the majority of the breast tissue sits below the level of the nipple. In a tuberous breast, however, because the gland is constricted and sits directly beneath the areola, it does not fill out the base of the breast. There is often tight, constricted skin at the breast base and an elevated inframammary fold.
Goals of Correction:
Correction of a Tubular Breast has multiple goals: increase the size of the breast, release the constricted gland so that it can be evenly draped atop the implant, lowering the inframammary fold, filling out the base of the breast, and decreasing the size of the areolar diameter. Clearly this is not as straightforward as a Breast Augmentation in a non-tuberous breast but great results are still possible. In order to get those good results, however, you need to have an experienced surgeon and a good deal of patience.
Operating on a Tuberous Breast is usually approached through a Periareolar incision (placed at the junction between the pigmented areola and the surrounding lighter skin). Through this incision, the preexisting, constricted gland can be released (scored) with cautery to help redistribute its volume. The lower pole of the breast is dissected out to accommodate the implant and the implant pocket is made. During expansion of the lower pole, the skin is stretched and the fold is lowered. Finally, the areola is resized by removing the excess skin circumferentially around it.
Why It’s Challenging:
Understanding the anatomic features of a Tuberous Breast and the specific goals we have in surgery better help to illustrate just why exactly these cases can be challenging. In my opinion, the hardest part of this surgery is expanding the lower breast pole. Because this skin has never been stretched out before, it can be extremely tight and resistant to filling out the projection of the implant in a rounded, aesthetically pleasing shape. Expanding the lower pole of the breast also means lowering the inframammary fold which can predispose a patient to complications such as bottoming out (when the implant continues to descend after surgery because of an unstable, unsupportive breast fold) or a double bubble deformity (persistent native breast crease). Lastly, circumferentially reducing the size of the areola while adding the volume of a breast implant can put pressure on the newly sized areola and cause it to widen again over time.
The body is incredibly adaptable but can seem slow relative to our desire to see immediate results. It can take time (I’m talking months) for the skin and tissue to stretch out at the base of the breast to give a natural appearance. In the interim, the implant may feel positioned unnaturally high. The same is true for the native (high) inframammary fold. While it may be present immediately after surgery as a slight crease, it often disappears over time as the skin stretches out and redistributes its tension. Patience is key.
Knowledge is power. Understanding the anatomy of, challenges from, and surgical techniques for a Tuberous Breast is the best first step to approaching your breast consultation.