Breast shape, size, symmetry and proportion relative to her body have a tremendous effect in every woman’s sense of femininity, and self esteem. Breast development starts at puberty, tuberous breasts influence psychosocial well-being and sexuality from a very early age on. While tubular breasts most often are smaller in size, they are not simply “small breasts” that have not completely developed. The physical characteristics of the tuberous breast deformity include constriction of the breast base, breast hypoplasia (small breast size or underdevelopment), breast skin deficiency, malposition of the inframammary fold (the level of crease above the areola), areolar herniation (above average puffiness or bulging of the nipple-areolar area), and breast asymmetry. Not all anatomic hallmarks have to exist in tubular breasts, women may have one, several, or all of these. Tuberous breast deformity degrees vary widely, and often demonstrate considerable discrepancies between both breasts in the same individual, resulting in asymmetry.

What is the Cause of Tuberous Breasts?

The tuberous breast deformity is a congenital breast anomaly. It becomes manifest at the time of puberty and breast development. The exact etiology is unclear, it is theorized that the deformity has an embryologic origin. Its physical manifestations are attributed to connective tissue ring-constriction around the areola, and underdeveloped areolar connective tissue support. This hypoplasia results in the puffiness and bulging of the nipple areolar complex. Asymmetry is seen commonly in tuberous breast deformity, with discrepancies seen in breast volume & shape, areolar size, and breast sag.

Is Breast Augmentation the Solution for Tuberous Breasts?

No, the anatomy of tuberous breasts and “small breasts” are completely different. Tuberous breast deformity correction is a different procedure that often incorporates breast augmentation when necessary, but requires technical maneuvers related to the breast gland to achieve aesthetic outcomes. The most common problem is that tuberous breast deformity in its milder forms is unfortunately underdiagnosed. When unrecognized, treating the less obvious tuberous deformity breast with only augmentation techniques will often fail to address the deformity. There is restriction of the breast lower pole, and addressing this with augmentation techniques only may worsen areolar herniation, This results in a less pleasing breast shape. In moderate and severe forms of tuberous breast deformity, breast reshaping, areolar reduction, and breast augmentation is indicated.
No two tuberous breast corrections are the same, since the degrees of severity and asymmetry differ in every person. As a double board-certified, plastic surgeon with a fellowship on reconstructive and aesthetic breast surgery, Dr. Cigdem Unal has a clinical focus in breast aesthetics.

Tuberous Breast Correction with Dr. Cigdem Unal

When the tubular breast deformity is severe, especially when there is size and shape discrepancy, women may be very focused on their breast asymmetry. In instances where the manifestations of the tubular breast deformity are less obvious, an individual may seek correction of breast hypoplasia (small breast size) only. She may not be aware of areolar prominence or herniation, breast constriction at the base and the high inframammary fold position. In both mild and severe cases, the breast base constriction, inframammary fold position, breast skin, breast volume, areolar herniation, and ptosis must be carefully examined to determine the best tuberous breast treatment techniques.

From your first consultation, throughout your recovery and follow-up period, you will experience a personalized treatment specially designed for you. You will feel the attention to detail, compassion and care that Dr. Cigdem Unal and her team provide for every patient she treats. Dr. Unal listens carefully and understands her your desires during the initial consultation and examination in order to inform you about the procedure(s) or treatments that will suit you best.

Dr. Cigdem Unal’s message to those considering tuberous breast correction

Tuberous breast correction requires meticulous assessment of your physical requirements and a careful understanding of your desires. An array of techniques can be applied to achieve the best tuberous breast surgery results. Tuberous breast correction is definitely much more than a breast augmentation; it is a creative process that requires experience and knowledge. It can dramatically improve breast shape and symmetry. Tuberous breast correction restores sense emotional well-being and self-confidence.

Careful assessment of anatomic features of tuberous breast deformity should be evaluated for each person. The individual issues may include one, several, or all of the following:

1. Breast base constriction – mild, moderate or severe
2. Inframammary Fold Position – normal laterally, minor elevation (medially or medial and lateral elevation), elevation of entire fold, or fold absence
3. Skin Envelope – inferior insufficiency, insufficiency in more than 1 quadrant, no insufficiency
4. Breast Volume – minimal deficiency (or hypertrophy on the contralateral side), moderate deficiency, or severe deficiency
5. Ptosis – none, mild, moderate, or severe
6. Areolar herniation – areolar enlargement, herniation, or severe herniation

These anatomic hallmarks of tuberous breasts are used to determine the type of tuberous breast deformity as well as the surgical technique that will be performed for each patient:

• Type I Tuberous Breast Deformity – Constriction only in the lower-inner quadrant breast some breast droop
• Type II Tuberous Breast Deformity – Constriction of the lower pole medially & laterally, breast hypoplasia, and areolar herniation
• Type III Tuberous Breast Deformity – the most severe form with great size, shape difference to the contralateral side

In selecting the appropriate tuberous breast correction technique for any tuberous breast deformity, there are four key components to consider:

1. The incision location through which the shaping of the breast as well as introduction of the implant is performed
2. The incision type for correction herniation, asymmetry, and ptosis (breast droop)
3. The pocket the implant will be placed
4. The number of stages required to achieve the best tuberous breast result

These variables in technique are adjusted for each and every patient with tuberous breast.

Preparing for Tuberous Breast Surgery

After an initial consultation,Dr Cigdem Unal, you will have a another preoperative visit in the office approximately 3-4 days before your surgery. Information and the pre and postoperative instructions about your surgery are reviewed by Dr Cigdem Unal. Anything that has a blood-thinning effect (aspirin, ibuprofen, green tea etc.) is to be avoided for two weeks before and 1 week after surgery. Routine lab testing and consultation by the anaesthesiologist is ordered, and any breast imaging studies that are required (age and past medical history appropriate) are obtained.

The Tuberous Breast Correction Procedure

In Dr. Cigdem Unal performs her surgery at fully accredites hospitals in Nisantasi, Istanbul. The procedure is performed under general anesthesia, administered by a board-certified anesthesiologist from the same hospital. The procedure duration is approximately 2.5 – 3 hours.
In any tuberous breast deformity surgery, the constriction at the lower pole of the breast is released by a technique called radial scoring. If any implants are to used, they are placed in dual plane (under the muscle). This softens the upper pole of the breast, maintains stability. It also helps lower pole expansion espically when anatomic implants are used.

One-stage tuberous breast correction with silicone breast implants can be selected in the majority of cases. In select cases of severe constriction and deficiency, a “two stage” approach may be required to adequately expand the skin and breast tissues. A tissue expander (which is a temporary adjustable saline implant) may be recommended at a first stage to be able gradually expand the lower pole tissue of the breast in order to abel to place a permanent implant. The temporary expander is filled in the following weeks after the first stage of surgery until adequate expansion of the lower pole of breast is reached. It is then replaced with a permanent breast implant of desired size, texture and type.

Recovery

You will recover in in the recovery room of the accredited hospital where your surgery will be performed with a registered nurse 1 hour, and will be staying at the ward overnight where you will be taken care of by the registered nurses of the hospital.

Dr. Cigdem Unal recommends returning to work or school after 1 week. During the first week you will wear a post-surgical bra. Drain tubes are used which remain in place for approximately 4–5 days. Breasts may appear firm and swollen for approximately 10–14 days, with shape and size apparent around 10- 14 weeks after surgery.

Exercise

Light exercise (cardio) may be resumed at one week, and more vigorous physical activity may be started at 5-6 weeks after surgery. Completely unrestricted training begins at 12 weeks.

Aftercare

Following the surgery, Dr. Cigdem Unal and our staff will be available to you day and night. Routine follow-up visits are 3 days after surgery,at one week, 3 weeks, and 3,6 and 12 months after surgery. Dr. Cigdem Unal will provide information regarding the follow up of breast health during your posperative period.

More Questions?

Dr. Cigdem Unal’s website and other web-based resources can be valuable in providing some basic information about tuberous breast deformity correction, however there is no substitute for a face to face consultation with a double board-certified plastic surgeon such as Dr Cigdem Unal. Tuberous breast surgery is a procedure that requires unique assessment and tailoring of surgical techniques for each patient, technical skill, anatomical understanding, and aesthetic vision to achieve natural results. We invite you to schedule a consultation to discuss tuberous breast correction in Istanbul with Dr. Cigdem Unal, and look forward to warmly welcoming you to our practice.

In this testimonial video of Prof Dr Cigdem Unal ‘s tubular breast reconstruction patient, you can find answers to questions you may also have about the surgery and the whole pre and posoperative period.