This is a 28 year old female who is 5’7″ and 200 pounds who came to the office with a wish for better breasts. She wanted to lose weight and be healthy. Her preoperative photos illustrate a classic case of “tubular breast condition.” This is not a deformity per se, just a situation that leads to breasts that appear narrow, with enlarged areola and usually with extension of the breast tissue into the areola (herniation of the breast tissue into the areola). The breast tissue is usually quite firm and localized to a small area beneath the nipple-areola complex and the “lower pole” or bottom of the breast is constricted (short) compared to the “normal.”
There is no doubt that “funny looking breasts” are not a desirable attribute. Many women come to my office with “different” breasts, and they would initially have me believe that it isn’t a big deal, but in short order, it becomes quite apparent to me that it is a big deal (as you would reasonably expect).
She is fuller figured with narrow breasts that sag, she has no cleavage, and her breasts are small for her larger frame. The main goal is fuller breasts that fit her figure and breasts that are shaped better. There are many alternatives to achieve this goal and if you visited with seven plastic surgeons you will probably come away with four different recommendations. There is no correct and incorrect way to treat this condition but an experienced surgeon will always give you better advice.
She is young. She has good skin. If I am able to add an implant to give her fullness and proportion, to “splay” the constricted breast tissue surgically and massage her aggressively afterwards to make the tissue conform, and mold around the implant, she would notice a nice improvement without a lot of scars. At the very least, it will set the stage for additional procedures that can be performed once a “stable foundation” of the breast is established. I saw no need for an immediate lifting procedure because I knew I could mold her into a very satisfactory shape without a lift.
She was enhanced with 450cc silicone implants placed above the muscle with treatment of the constricted breast tissue so that it “opens up” and is less narrow. Sometimes this can result in a “snoopy” breast where you have a round mound with a smaller one on top of it. This has been avoided by postoperative massage to essentially mold the breast tissue on top of the implant. I chose the subglandular position of her implants because she has thick tissue and good skin and the ability to shape the breast in her case will be easier with the implant in this position. However, this puts her at higher risk for breast contracture.
She has lost twenty pounds since her procedure and seems like a totally different young lady (in a very good way).
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