Tuberous Breast Correction

Breast shape, size, symmetry and proportion play a unique role in every woman’s sense of physical balance, femininity, and confidence. Becoming obvious to most women during the earliest phases of puberty and breast development, tuberous breasts can deeply influence psychosocial well-being and sexuality. While tubular breasts may be deficient in size, they are not simply “small breasts” that have not completely developed. The characteristics of the tuberous breast deformity include breast constriction, breast hypoplasia (small breast size or underdevelopment), breast skin deficiency, malposition of the inframammary fold (the crease beneath the breast), areolar herniation (puffiness or bulging of the nipple-areolar area), and breast asymmetry. Women may have one, several, or all of these anatomic hallmarks. Tuberous breast deformities are widely variable, and often demonstrate considerable discrepancies between both breasts in the same individual resulting in frequent asymmetry.

What is the Cause of Tuberous Breasts?

The tuberous breast deformity is a congenital breast anomaly that 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, and while there may be a genetic predisposition, no clear link has been determined with tuberous breasts. Its physical manifestations are attributed to a combination of connective tissue ring-constriction around the areola, and thin or hypoplastic areolar fascial (connective tissue) support. This can result in the puffiness and bulge of the nipple areolar complex. Asymmetry is a common hallmark of tuberous breast deformity, with discrepancies seen in breast volume, shape, areolar size, and breast droop.

Is the Treatment for Tuberous Breasts the same as a Breast Augmentation?

No, there are considerable differences between tuberous breast correction and breast augmentation. Tuberous breast deformity correction is a very specialized procedure that often incorporates breast augmentation when necessary, but requires a variety of nuanced technical maneuvers to achieve the most consistent aesthetic outcomes. The most common problem is that tuberous breast deformity in its milder forms is commonly underappreciated and underdiagnosed. When unrecognized, treating the less obvious variants of the tuberous deformity with more common breast augmentation techniques will often fail to appropriately address the deficiencies and restrictions of the breast lower pole, and may worsen areolar herniation, resulting in a less pleasing breast shape. Moderate and severe forms of tuberous breast deformity require a delicate balance of breast reshaping, areolar balancing, and breast augmentation as indicated by the tubular breast deformity type and individual desires.

With so many different degrees of severity and asymmetry, no two tuberous breast corrections are the same. Each is as different as the individual’s breast shape, body type, and unique goals, and as different as the breast surgeon who performs them. As a double board-certified, Harvard-trained plastic surgeon with a clinical focus on aesthetic breast surgery, and having published and lectured on tuberous breast deformity and methods of treatment, Dr. Kolker has a long-standing interest and specialty in safely achieving consistent and beautiful results with tuberous breast correction.

Before & After Gallery

View Before & After Gallery

View Dr. Kolker's tuberous breast correction gallery. These before and after photos will assist you in understanding your various options and enable you to set realistic goals for your own surgical outcome.

Hear From Dr. Kolker's Patients

Dr. Kolker has developed new surgical techniques that help patients achieve the most amazing results I'd ever seen. My results were better than I'd ever imagined. My new breasts were normal in shape, symmetrical, and natural looking. I couldn't believe it was me. For the first time, I feel beautiful. My body no longer holds me back from being the person I was meant to be. I want to share my story to get the word out that this isn't just a cosmetic condition. Tuberous Breast Disorder (TBD) can destroy a woman's self-esteem and her ability to live a happy life. If even one woman finds comfort in knowing she's not alone or learns that this can be corrected, telling my story will have been worth it.K.R. / New York City

Tuberous Breast Correction with Dr. Kolker

When the tubular breast deformity is of a moderate or severe grade, women may be very focused on their breast shape, size, and symmetry issues. In certain instances where the manifestations of the deformity are milder, an individual may seek correction of breast hypoplasia (small breast size) only, and may not be aware of areolar prominence, breast constriction, inframammary fold malposition, and other mild shape aberrations. In all cases, the specific physical manifestations of breast base constriction, fold position, breast skin envelope, breast volume, areolar herniation, and ptosis must be carefully qualified and quantified, and then married with your unique desires to determine the best tuberous breast treatment techniques. The technical approach must be meticulously personalized and customized for every nuance of inherent shape and size and for every aspect of individual desire.

The plastic surgeon you choose for aesthetic correction of tuberous breast deformity is vital. What differentiates care by Dr. Kolker and his team is comprehensive:

Vast experience in tuberous breast correction,
Exceptional finesse and technical skill,
Superior certification, accreditation, and safety standards,
Aesthetic and anatomic perspective of beautiful, natural, and proportional breast and body aesthetics,
A passion for attaining gorgeous results that can be truly transformative,
A deep understanding of the physical and emotional impact of developmental breast deformity,
A connection between patient, surgeon, and staff that is extraordinarily warm, familiar, and comfortable.

With a great interest in advancing both the artistry and science of tuberous breast correction surgery, Dr. Kolker has published a classification and aesthetic technical approach to tubular breast deformity in the article entitled “Tuberous Breast Deformity: Classification and Treatment Strategy for Improving Consistency in Aesthetic Correction” in the January 2015 issue of the peer-reviewed journal, Plastic and Reconstructive Surgery, and has lectured on this topic at the annual meeting of the Northeastern Society of Plastic Surgeons in Washington, DC, September, 2013. Dr. Kolker has also published his work on this type of developmental breast hypoplasia and asymmetry entitled “Tuberous breast deformity: principles and practice.” in the December 2000 issue of the scientific journal, Annals of Plastic Surgery.

From your first consultation, during the perioperative phase, and throughout the recovery and follow-up period, you will experience the meticulous attention to detail, compassion, and warmth with which Dr. Kolker and his team welcome and care for you. Your first visit is an opportunity for Dr. Kolker to understand your desires, to examine and evaluate physical needs and to thoroughly inform you about the procedure(s) or treatments that will suit you best.

DR. KOLKER’S WORK PUBLISHED IN THE JOURNAL PLASTIC AND RECONSTRUCTIVE SURGERY

Advances in Tuberous Breast Deformity Correction

With extensive experience in the treatment of tuberous breast deformities, Dr. Kolker has had a career-long interest in the developmental anatomy of tuberous breast deformity, and in exploring and improving plastic surgery techniques for the correction of tubular breasts and breast asymmetry. In his article published in the preeminent peer-reviewed plastic surgery journal, Plastic and Reconstructive Surgery, Dr. Kolker reviews his classification system, a treatment algorithm, and the technical nuances in plastic surgery for tuberous breast correction, all geared toward maximizing safety and consistency in aesthetic results.

Read Article

Dr. Kolker’s message to those considering tuberous breast correction

The art of tuberous breast correction is a multifaceted process. After a meticulous assessment of your physical requirements and a careful understanding of your unique desires, a variety of techniques are applied in concert to achieve the best tuberous breast surgery results. Tuberous breast correction is much more than a breast augmentation; it is a supremely creative and sculptural process that can dramatically improve breast shape, size and symmetry, and can establish a sense of physical balance, emotional well-being and self-confidence.Dr. Adam Kolker

Planning Tuberous Breast Surgery

The cornerstone of tuberous breast correction is a clear and careful definition of the specific anatomic issues associated with the breast deformity. The individual issues may include one, several, or all of the following, and depicted in the diagram below:

Breast base constriction – mild, moderate or severe
Inframammary Fold Position – normal laterally, minor elevation medially, medial and lateral elevation, elevation of entire fold, or fold absence
Skin Envelope – sufficient, inferior insufficiency, or global insufficiency
Breast Volume – minimal deficiency (or hypertrophy), moderate deficiency, or severe deficiency
Ptosis – none, mild, moderate, or severe
Areolar herniation – areolar enlargement, herniation, or severe herniation

Tuberous Breasts Treatment NYC

These anatomic hallmarks of tuberous breasts are then used to determine the type of tuberous breast deformity:

Type I Tuberous Breast Deformity – generally a milder form with lower-inner quadrant breast constriction and some breast droop
Type II Tuberous Breast Deformity – varying presentation with more lower pole constriction, breast hypoplasia, and areolar herniation
Type III Tuberous Breast Deformity – the most severe form

Treatment of Tuberous Breasts

In selecting the best tuberous breast correction techniques for any type of breast deformity and desire, there are five key components to consider:

The incision location through which the shaping maneuvers are performed (and the breast implant is introduced)
The type of breast implant, silicone or saline
The incision type for correction and control of areolar herniation, asymmetry, deformity or ptosis (breast droop)
The pocket placement of the implant relative to the chest muscle
The number of stages required to achieve the best tuberous breast results

These variables in technique are tailored to your specific anatomy and your desires. The following is an algorithm that summarizes the various approaches that can be used:

The specific tuberous breast correction plan will be formulated based on your innate anatomy, tuberous breast features and breast shape, and on your personal preferences. Dr. Kolker will carefully discuss all of these factors with you, and will design the best tuberous breast correction method that is uniquely personalized to achieve your goals.

Preparing for Tuberous Breast Surgery

After an in-depth initial consultation, you will have a comprehensive preoperative visit in the office approximately two weeks before tuberous breast surgery. Prescriptions for medications to be taken before and after surgery are given, and the pre and postoperative instructions are reviewed. Sizing exercises (with neoprene inserts of varying size placed into a special bra) are performed at this time. Anything that has a blood-thinning effect (aspirin, ibuprofen, etc.) is to be avoided for two weeks before surgery. Routine lab testing 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. Kolker’s fully accredited surgical facility located on Park Avenue in New York, tuberous breast correction is performed as an outpatient procedure. The surgical suite is accredited by the AAAASF (American Association for the Accreditation of Ambulatory Surgery Facilities). The procedure is performed under general anesthesia, administered by a board-certified anesthesiologist from the Mount Sinai Medical Center Department of Anesthesia. The procedure duration is approximately 2.5 – 3 hours.

Common to most tuberous breast procedures is the release of lower pole breast constriction with a maneuver called “radial scoring”. This allows for the shaping of a more rounded lower pole of the breast from the inside.

The “pocket location” for the breast implants with tuberous breast correction can be below the muscle (submuscular augmentation), or above the muscle (subglandular augmentation). Because submuscular breast augmentation provides increased coverage of the implant, softens the upper pole of the breast, maintains long term stability of the pocket, decreases rates of capsular contracture, and lessens influence on mammography, Dr. Kolker uses a submuscular pocket plane exclusively for all tuberous breast corrections. In treating tuberous breasts, “dual-plane” augmentation is the type of submuscular augmentation that is most appropriate with the glandular shaping maneuvers used by Dr. Kolker. This dual-plane approach promotes coverage of the upper pole of the implant by muscle, and direct expansion of the often deficient lower breast gland.

One-stage tuberous breast correction with silicone breast implants or saline-filled 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, which can be sequentially filled over the course of weeks or months following the initial surgery to achieve the best breast size, shape and proportion. It is then replaced with a permanent breast implant of desired size, texture and type.

Recovery

You will recover in our private recovery room in our office in New York City with our registered nurse, and will be discharged home with a friend or family member when you are fully awake and comfortable, generally 1–2 hours after the completion of surgery.

Dr. Kolker recommends returning to work or school after seven days, although with less physically demanding occupations, some may resume work as early as 4–5 days postop. During the first week you will wear a post-surgical bra provided by the office. 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 12 weeks.

Exercise

Light exercise (cardio without impact) may be resumed at five to seven days, and more vigorous physical activity may commence three weeks after surgery. Strength training that excludes pectoralis muscle contraction (including lower body, core, and biceps/triceps toning with arms held below 45 degrees) may resume after seven days. Modified pectoralis exercises may be resumed at 4–6 weeks, and completely unrestricted training begins at 12 weeks.

Aftercare

Following the surgery, Dr. Kolker and our entire staff are at your disposal, and available to you day and night. Routine follow-up visits are at one week, six weeks, and 12 months. Dr. Kolker will provide information regarding breast health, breast self-examination, exercises, and the timing for any breast imaging as required.

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