Correction of tuberous / constricted breast deformity.
May require a combination of breast augmentation, mastopexy, areolar reshaping and fat transfer. In severe cases, patients may require multiple procedures in a staged fashion.
Plastic surgeon’s fee: from $TBC
Total approximate cost (uninsured patient, day surgery only): from $ TBC
Total approximate cost (insured patient where item number applicable): from $ TBC
Associated item number: 45060,45061, 45062
LENGTH OF PROCEDURE/HOSPITAL STAY:
Day surgery for most patients; insurance will cover cost of overnight stay for appropriately insured patients.
Tuberous breast is a way of describing a number of breast characteristics which may be present to some degree for many women. Tuberous breast (also called “constricted breast”) is a developmental abnormality of the breast, and therefore correction of tuberous breast in a patient who has been appropriately diagnosed is a reconstructive procedure, with associated coverage by Medicare and private health insurance.
Tuberous breast is a spectrum, from subtle changes through to severe deformity. Classically, the tuberous breast appearance involves a degree of constriction of the lower pole of the breast. This may lead to a variety of breast shapes, ranging from a tight, flat lower part of the breast (in a small breast), to the so-called “Snoopy nose” appearance (in a large breast, the breast points downwards, with a high crease position and the areola at the tip of the “nose”). The most severe cases result in a failure of normal breast development with herniation of the breast tissue behind the areola.
Very frequently, the tuberous breast shape may only affect one breast, or it may affect both breasts to a different degree. Some patients will have an enlarged tuberous breast on one side, with a small (hypoplastic)constricted breast on the other side. It is common that different operations are required on each side.
Some patients will present as teenagers, having noticed the shape of the breast during puberty and breast development. Other patients will present later in life, often having felt unhappy with their breast shape for some time without realising that their breast shape is the result of a developmental anomaly.
Correction of asymmetry – Some patients will have a single tuberous breast, or they may have bilateral tuberous breasts of differing size and characteristics. For patients with a large tuberous breast,the surgery required is usually a breast reduction or breast lift, depending on whether size matching to the opposite breast is necessary. This allows the tuberous breast shape to be corrected and the breast can be repositioned appropriately for the patient’s body and age.
If there is one smaller breast, this breast may require enlargement and this can be achieved by fat transfer, breast implants or a combination of the two. Alternatively, the larger breast can be reduced to match the smaller breast.
The decision to use a breast implant on only one side can create longer term challenges, and generally we recommend that if breast implants are required, the best results are achieved if implants are used in both breasts with any asymmetry correction being achieved by removal of tissue from the larger side. If the size difference between the two breasts is substantial, this surgery must be carefully planned.
Breast reshaping – The reshaping of the tuberous breast may be achieved with a breast lift or reduction where the breast size allows it. This is the easiest way to reshape the breast as the surgeon can reposition the breast tissue as required.
Reshaping a smaller breast which is constricted may be more challenging. Creating the typical curve of the lower pole of the breast may require simple breast enlargement (either with fat transfer or with an implant). In more severe cases, the degree of constriction may be so great that the skin of the lower part of the breast has to be stretched and reshaped by the use of inflatable breast implants called tissue expanders. These temporary breast implants are inserted and then gradually pumped up over time to stretch the skin and breast tissue, overcoming the constriction, and once the tissue has been stretched sufficiently, the tissue expander can be replaced with a breast implant or fat transfer at a second operation.
Some patients may have a tight, scar-like band of tissue in the lower part of the breast which creates the constriction, and this band of tissue must be released to allow the breast to expand into the correct shape.
“Breast lift” – Patients who have a breast which is tuberous, but with sufficient volume, will require a breast lift (mastopexy) to appropriately reposition the tissue, and this also allows re-sizing of the areola (which is typically enlarged). Some patients a reduction in the size of the breast at the time of the breast lift to correct for volume asymmetry.
Areolar re-sizing – Patients with tuberous breasts (whether large or small breasts) will frequently have enlargement of areola,and there may be herniation of the breast tissue behind the areola. The mechanism by which the tuberous breast shape forms during development involves scar like bands of tissue (which would normally have separated during breast development, but in the tuberous breast this process fails to occur) and there is typically a tight “ring” of tissue behind the areola which doesn’t allow the breast to expand as it grows during puberty. This ring shaped band has a central gap (behind the nipple and areola) and so as the breast enlarges during puberty, the tissue is forced through this “weak spot”, creating a herniation of the breast tissue into the areola. This exacerbates the stretching of the areola over time. Patients who have this feature will require some kind of mastopexy to allow for areola re-sizing at the same time as the band of tissue is released to normalise the breast shape.
Tuberous breast is a developmental abnormality. Many patients are unaware that tuberous breasts can be corrected, often in a single operation. Patients with tuberous breasts may experience distress, embarrassment or self-image concerns, particularly during their teenage years. Unfortunately, awareness of tuberous breast is relatively low in the community and even amongst general practitioners (who may be the first point of contact for young ladies with their parents).
Tuberous breast surgery may be indicated for patients who present with any of the following:
Dr Campbell-Lloyd believes strongly in performing surgery that leaves patients with natural and long-lasting results.
There are natural, implant-free techniques available to correct many forms of tuberous breast deformity, but some patients will require the use of breast implants.
If breast implants are used in any way for correction of tuberous breasts, the best results will only be obtained when implants of similar size are used in both breasts. The use of a breast implant only on one side to enlarge a smaller breast to “match” a larger breast is unlikely to provide a stable long term result.
We strongly recommending reducing a breast that is larger to match the smaller side, where feasible.
Once the breasts match in size, they can be reshaped or resized as necessary using a number of different techniques.
It is important to understand that using breast implants (even in reconstructive surgery) will lead to a requirement for ongoing implant assessment, and eventually additional surgery, in every case.
Before & After Photos.