Tubular breasts are believed to occur in over 5% of women. The condition may involve only one breast (unilateral) or both breasts (bilateral). It results in significant asymmetry (differences between the right and left sides), making it difficult to find clothes and under garments that fit. It is believed to occur (during puberty) as a result of a constricting fibrous ring at the level of the outer border of the nipple- areola complex that inhibits normal breast development. Due to this constricting ring of tissue, the breast is unable to expand laterally causing it to bulge through the areola.
Although each case differs, the main characteristics of the condition are:
Several classification systems have been developed to describe the condition and aid in treatment planning.
- Enlarged areola with protrusion of breast tissue into the areola. (puffy nipple)
- Elevated inframammary fold.
- Reduced breast size (volume decrease).
- Smaller skin envelop covering the breast with a constriction of the breast base.
Treatment goals are based on individual findings including:
- Lower the inframmary fold to a more natural position.
- Expand the constricted breast tissue.
- Increase the volume of the breast.
- Reduce the areolar size and protrusion.
In my practice, evaluation begins with a discussion of patient goals. Presurgical workup includes physical examination, specific breast-chest measurements, implant size and style selection, additional breast studies where indicated (these may include mammography, ultrasound, MRI depending on the individual assessment), and laboratory testing. Implant type and style is an important part of this presurgical planning. Usually a high profile smooth round implant is chosen. This has the advantage of additional breast lifting. I do not recommend tear dropped shaped implants where there is a tubular breast deformity. Although either saline or cohesive gel implants may be chosen, in most cases a cohesive gel implant is used.
Before and After Breast Lift Results by Dr. Robert Burke
Implants are usually placed through a periareolar incision. This aids in proper implant positioning and more accurate lowering of the constricted inframammary fold. Depending on individual needs, a concomitant resizing of the nipple-areolar complex may be done at the same size, and the breast lifted (mastopexy).
This patient was a mother in her 30's. She complained of breast asymmetry and had found it difficult to find clothes that fit. Following evaluation, round smooth high profile cohesive gel implants were placed. A mastopexy (lift) with resizing of the nipple-areolar complex was done at the same time.
By Dr. Robert Burke Ann Arbor Michigan Cosmetic Surgeon