Hey, it’s ok …
It is just a Tuberous Breast Deformity
Patients with a tuberous breast deformity are mostly unaware of the deformity and merely express dissatisfaction in terms of the appearance of their breasts. These patients have been unhappy and embarrassed of their breast for many years not knowing that surgical correction is possible.
The tuberous breast deformity serves multiple challenges to both the patient and the surgeon.
The tuberous breast is a congenital anatomical variant of breast shape, size and form. If one imagines the breast to be divided into 4 quadrants with the nipple at the center the tuberous breast shows various features. These features are present in various combinations and unique to a particular individual.
The typical features seen in the tuberous breast deformity are as follows:
1. Hypoplasia or underdevelopment of some, or all 4 quadrants of the breast. Mostly the lower quadrants, giving the breast a triangular or tubular appearance with a tight base.
2. An enlarged areolar, constricted at the base pointing downwards. In severe case the breast mimics “snoopy-dog” and referred to as the snoopy breast.
3. Asymmetry between the breasts, with the one breast often 2 cups bigger than the opposite side
Surgical correction of the tuberous breast if one of the most challenging in breast surgery. The challenge include restoration of the volume, correction of the nipple-areola and most difficult, matching the two breasts in size, shape and nipple position. For this reason the anatomical deformity can rarely be corrected in a single procedure. Patients may require two to four operations to correct the deformity.
Because of the uniqueness of the deformity of each breast and the great variation between breasts in the same individual, there unfortunately does not exist a “one procedure fits all” in tuberous breast correction. Thus tuberous breast correction involves a combination of the following procedures:
Mastopexy or Breast Lift, to lift the descended breast to a more attractive position. This procedure provides the best result if the cuts are approached via the inverted T or anchor incision as appose to around the nipple or peri-areolar. Incisions around the nipple seem to stretch the nipple over time making the areola wider and in time the one side will stretch more than the opposite side leading to unattractive unequal nipples.
The inverted T incision does not stretch the nipple due to an alteration in the distribution of forces acting on the nipple. All nipple areolar areas will stretch as we age but the inverted T incision stretches less than the peri-areolar or “lollipop” incision.
Unfortunately it does involve a cut around the nipple, in the middle down and at the base of the breast. The scar around the nipple does not form a major problem and becomes invisible over time due to the transformation of the skin colour from dark to light. The scar at the base is hidden in the fold of the breast and the scar in the middle lightens over time. I do however suggest laser treatment after the procedure to further improve the scarring.
Breast Reduction, It may be necessary to reduce the size of one or both of the breasts in order to achieve symmetry. It may also be useful to aim at obtaining a similar size of native breast tissue before attempting restoration of volume using a silicone implant. The reduction approach is also through the inverted T incision as described above and the amount of reduction depends largely on the size of the opposite breast as well as the desired size of the breast.
Breast Augmentation, Breast augmentation using a silicone implant is perhaps the easiest, quickest and most reliable way to increase the size of the breast.
Unfortunately once you have one set of silicone implants you would definitely require another procedure to replace the silicone prosthesis. Silicone prosthesis are like tires for your car sooner or later they will need replacement. The exact timing is unsure but the FDA currently recommends replacement at 10-15 years. I recommend that you have a clinical examination and ultrasound or mammogram once a year to assess the integrity of the implant.
I only use smooth silicone implants as current literature suggest an association between textured implants and anaplastic large cell lymphoma. I also don’t use saline implants due to the risk of spontaneous deflation and the slushing sound as a filled balloon. The silicone polymer is so designed that the carbon bonds prevents dissociation of the silence thus decreases the risk of a leak as well giving the breast a natural soft appearance.
Tuberous breast correction is a complicated surgical procedure. Due to the complexity of the procedure there may be an increased risk in the development of capsular contracture should a silicone prosthesis be used. That means the prosthesis may become hard as the body encapsulated the prosthesis. The capsule is a normal process whereby the body protects against a foreign body. Hardness of this capsule occurs over time but may occur earlier in some patients due to a variety of causes the exact of which is largely unknown. Once you have developed one capsular contracture the risk of a subsequent capsule is about 80%, on an immunological basis the body has become sensitized to silicone thus resulting in a capsule forming with the next set.
Fat Fills, Adipose derived stem cell obtained by liposuction not only provides fat to fill breast and increase size but also improves the quality of the skin and breast tissue. Unfortunately multiple fat filling procedures may be needed. As much as 40 – 60 % of the fat may be absorbed by the body. Every patients is different I have seen complete absorption to almost no absorption. I think it may be related to metabolic rate and smoking.
Above mentions a list of the most commonly performed procedures in tuberous breast correction. In reality I mostly perform all of these procedures in a tuberous breast correction either during the first stage or during subsequent stages. Thus together we will decide on the most appropriate course of action.
Complications,
I just feel that it may be important to be aware of the most complications associated with tuberous breast correction.
–The abnormality will not be corrected in one procedure
–You will require additional surgery. Either to improve the result, replace prosthesis or overcome the inevitable effects of gravity. However breast surgery is not like buying shoes. We do not want to operate on you in your teens, twenties, thirties, forties, fifties, sixties, seventies and beyond. Every time you have a procedure on your breasts the tissues become thinner and thinner and you risk of complications increases exponentially. Thus we should stage your procedures in a comprehensive safe manner.
-The breast will never be exactly the same. No women’s breast are exactly the same due to the dominance of the once side of the body and various other structural difference. None the less I aim to achieve as much symmetry as possible.
-You may develop hard lumps in your breast due to the development of fat necrosis. Fat necrosis is the way the breast tissue scars. These lump are easily disenable on an ultrasound and will decrease in size but will never disappear completely.
– Because the tuberous breast correction is a complicated procedure you are at an increased risk of bleeding shortly afterward i.e. in the first 24 hours after the surgery for which we may need to return to theatre.
– You are also at an increased risk for the development of a capsular contracture due to the complexity of the procedure. A capsular contracture is firstly managed by tablets followed by fat injection, replacement, multiple replacements and finally by removal if deemed necessary.
These are a few of the most common complications that I can think of. We will also provide you with information on each of the procedures.
The Procedure
The procedure takes about two hours, you will be in hospital for one night. After the procedures you will have two drains. The drains stay for about a week. I will have to see you once a week until all the wounds are healed. I would recommend you take off work for about 2-3 weeks. Physical exercise would probably start at about 6 weeks to 3 months depending on your recovery.
I hope the above has helped you. I am so proud of you for seeking help, together we will make it better.
Thank You