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Dr. Megan Dreveskracht
Jul 15, 2021
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TUBEROUS BREAST
SEATTLE
If your breasts have always looked different from what you see in magazines or in friends — constricted, asymmetric, or with areolas that seem too large for the breast itself — you may be dealing with a congenital condition called tuberous breast deformity, not something you did or didn't do. Many women live with this for years without knowing it has a name, or that correction is even possible, and the self-consciousness that comes with it is real. Correcting it is genuinely more complex than a standard augmentation, and it deserves a surgeon who treats it that way.
WHAT IS A TUBEROUS BREAST?
Tuberous breast deformity is a common congenital breast condition involving some combination of a constricted breast base, herniation of the areola (where breast tissue bulges through and enlarges the areola), and asymmetry between the breasts. In its mildest form, it can be subtle enough that even a trained eye might miss it. In more severe cases, it presents real challenges to achieving a natural-looking, proportionate result — challenges that are different from, and often greater than, a standard Breast Augmentation.
Anatomically, a tuberous breast tends to be smaller because the breast gland itself is constricted and sits directly behind the nipple and areola, rather than spreading out to fill the lower breast the way it does in a typical breast. That constriction often causes the gland to bulge through the areola, which is part of why the areola can look enlarged. There's frequently tight, restricted skin at the base of the breast, along with a breast crease positioned higher on the chest than usual.
It's also common for tuberous breast deformity to affect only one breast, which means it often shows up alongside — or as a cause of — overall breast asymmetry, not as an isolated, symmetric condition.
A CLOSER LOOK
Correcting a tuberous breast has several goals working together, not just one: increasing overall breast size, releasing the constricted gland so it drapes evenly over an implant, lowering the breast crease, filling out the base of the breast, and reducing areolar size. None of these happen in isolation — adjusting one affects the others, which is part of why this surgery takes real experience to get right and why results develop more gradually than they do after a standard Breast Augmentation. During your consultation, I'll walk you through exactly how your specific anatomy affects each of these goals.
THE PROCEDURE
Surgery begins through a periareolar incision, placed at the border between the darker areolar skin and the surrounding breast skin. Through that incision, I release, or score, the constricted breast gland with cautery so its volume can redistribute more naturally. I then dissect the lower pole of the breast to make room for an implant and create the implant pocket. As the lower pole expands, the skin stretches and the breast crease lowers into a more natural position. Finally, I reduce the areola by removing excess skin around its circumference.
THE CHALLENGES OF CORRECTON
This surgery has specific technical challenges that are worth understanding before you go into it. Expanding the lower pole of the breast means working against skin that's naturally tight and resistant to filling out around the implant in a rounded, natural shape. Lowering the breast crease at the same time can increase the risk of complications like bottoming out — where the implant continues to descend after surgery because the crease isn't stable enough to support it — or a double bubble, where the original, higher crease persists as a visible line beneath the new one. Reducing the areola and adding implant volume are, in a sense, two opposing forces happening in the same surgery: shrinking the areola means removing skin, while placing an implant stretches and adds tension to the skin that remains. That tension along the new areolar border is part of why it can widen again over time, and it's also why some patients need a secondary areolar reduction later, once the implant pocket and surrounding skin have fully stabilized.
AM I A GOOD CANDIDATE?
If you have a constricted breast base, areolar herniation, or noticeable asymmetry between your breasts, and you're in good general health, you're likely a candidate for tuberous breast correction — a consultation and physical exam is the only way to know the specifics of your case.
Beyond the basics, your candidacy comes down to a few specifics I evaluate in person during your consultation:
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The severity of your constriction and asymmetry, since mild cases require a different approach than more significant ones
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Your goals around breastfeeding, since any breast surgery — including this one — carries some risk of affecting future breastfeeding ability
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Your patience for a longer, more gradual result, since it can take months for the skin and tissue to stretch and settle into their final, natural appearance
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Whether insurance is a consideration — correction of a tuberous breast deformity is typically not covered, since it's classified as cosmetic
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Whether you may need a secondary areolar reduction later, once your implant pocket and skin have stabilized from the initial surgery, to reach your ideal areolar size
I want to set expectations honestly: this is a more technically demanding procedure than a standard augmentation, and results take longer to look natural. In the weeks after surgery, your implant may sit higher than it will eventually settle, and your new breast crease may be visible as a slight line before it fades as your skin adjusts. That's a normal part of the process, not a sign anything went wrong — but I'd rather you know that going in.
RECOVERY
Recovery from tuberous breast correction follows a similar early path to a standard Breast Augmentation and Breast Lift — I don't use drains for this procedure, and your incisions are covered with tape rather than stitches you need to manage yourself. Most patients describe the first several days as pressure rather than pain, and ice packs along with sleeping upright both help keep swelling down. If you need something stronger than over-the-counter pain relief, it's typically only for the first few days. Most patients take about a week off work, though that depends on the physical demands of your job.
Because of how much the skin and lower pole need to stretch and adapt, it's especially important with a tuberous breast to give it up to six months before really assessing your final shape — results here take longer to settle than they do after a standard augmentation. In some patients, the lower pocket is naturally difficult to expand, and I may have you massage the breast to help encourage that tissue to soften and stretch. A soft strap worn across the top of the breast can also help, applying light downward pressure to keep the lower pole expanded as it heals. Every tuberous breast is a little different — because this condition exists on a spectrum, how quickly your particular anatomy settles into its final shape will vary too.
TUBEROUS BREAST
FAQ
01
Will Insurance Cover Correction of My Tuberous Breast Deformity?
Likely, insurance will not cover the surgery needed to correct a tuberous breast deformity.
02
Can Tuberous Breast Correction Affect Breastfeeding?
While breast feeding with a breast implant is considered safe, all surgeries of the breast pose a risk of decreasing a woman's ability to breastfeed.
03
What Is Tuberous Breast Deformity?
In the areas of fat harvesting with liposuction, compression garments should be warn a minimum of three months following your plastic surgery procedure.
04
When Can I Resume Exercise After Tuberous Breast Correction?
Lighter exercise can be initiated as early as three weeks following your plastic surgery procedure. Be sure to check with your plastic surgeon prior to initiating any exercise.
MORE TUBEROUS BREAST FAQS
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