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Michael Law MD Aesthetic Plastic Surgery

Tuberous Breasts

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Many patients considering breast augmentation are seeking to not only enhance the volume of their breasts, but to also enhance the shape and/or improve the symmetry of their breasts. Essentially all breast shape and symmetry issues can be improved during breast augmentation, and with most of them it is possible to make significant improvements and produce an aesthetically desirable breast profile. Accurate preoperative evaluation, appropriate surgical planning and attention to detail during the surgery are all crucial elements in achieving this goal.

Breast asymmetry is extremely common, and in fact essentially all breasts have some identifiable and measurable asymmetry. So the goal of surgery is not really perfect symmetry, as that does not exist in nature, but rather to produce the closest approximation of symmetry that is possible. In some cases it is possible to improve size asymmetry by using implants of different volumes and/or profiles. To do so one must patiently evaluate a wide variety of implant sizers intra-operatively with the patient in the upright sitting position. In some cases the breasts appear to be similar in volume, but asymmetries in the projection of the chest wall may mandate the use of different size implants in order to produce the closest approximation of symmetry.

For some patients it is actually quite important to reduce the volume of the larger breast (hence the somewhat confusing term ‘reduction augmentation’), which in turn allows the surgeon to use implants of the same or similar size. If there is a significant difference in breast volume, and one attempts to address that difference solely by using implants of different size, then the result may be acceptable early on but as time passes the breasts will age very differently. The smaller breast with the larger implant will tend to remain youthful and perky-appearing, while the larger breast with the smaller implant will gradually become droopy-appearing and may eventually assume the appearance of a breast hanging off of a small implant. Not a pretty picture.

Other shape issues are quite common, including one known as ‘tuberous breast’. Tuberous breasts tend to be narrow at the base and are overly projecting for their size, and this phenomenon may occur on one or both sides. In its mildest form, the lower pole of the breast is underdeveloped or may even appear constricted – sometimes referred to as a ‘constricted lower pole’. In severe cases the breast is conical in shape and is sometimes described by the patient as looking like a ‘torpedo’ or a ‘Snoopy dog’. Regardless of the degree of tuberosity, it is possible to dramatically improve the appearance of the tuberous breast during augmentation surgery using a number of specialized surgical techniques.

Many patients with severely tuberous breasts have said that they have never removed their bra in an intimate setting. Careful patient assessment, thoughtful planning and attention to detail during the surgical procedure can produce a dramatic and life-changing improvement for most patients with tuberous breasts.

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