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

These are severe cases if Tuberous Breast Deformity, and yours may be better or worse. There are different degrees of deformity from mild to severe

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.