Today I saw a patient who had been operated on for a condition known as “Tuberous Breast deformity” and asymmetry. Tuberous breast deformity occurs when a patient has a narrow base of the breast. The fold underneath the breast is tight or narrow and the breast mass appears to hang over the breast base. The term “Tubular” breast deformity is also used to describe this as the breast does look like a tube instead of rounded. Some patients are also unfortunate in that their breasts are also of different size.

These patients present a challenge from the technical point of view. There is no accepted general consensus on how to “fix” a “tuberous” breast, which means no single approach works well for everybody. On top of that, you have to make the two different sized and shaped breasts match. Unlike cancer patients, who are battling a grave disease, and realize their involved breast is somehow “damaged” and in need of “reconstructive” surgery, the “tuberous” breast deformity patient wants to make her natural breasts “match” and be “prettier” than they are now. Their expectations are much higher than the mastectomy patient. From the surgeons viewpoint, the surgery is more difficult than a breast reconstruction and the patient harder to please.

The patient I saw today was very unhappy with the previous surgeon. She was very concerned about scarring. She wanted “natural looking” breasts. Looking at her, I think I understand what the previous surgeon thought. Since she was so adamant about scarring, he decided to place the scar under the breast fold. This would hide the scar, but would eliminate the chance to reposition the “nipple-areolar” complex. As a result the patient got a “hanging breast” with a downward pointing nipple, which looks “natural”, as the patient stated she wanted, but not as she was hoping for. I offered the patient a supraareolar scar (at the upper border of the areola) to bring the nipples to better position, and adjustable implants. She wanted to think about it but I could tell she was not thrilled.

In summary, patients with asymmetry have to be psychologically ready for a certain amount of scarring. I use the “suprareolar scar”, as it is a minimal amount of scar compared to the “inverted T” scar. The patient also should know she is going to look better, not perfect. Most patients are very happy, and this procedure really does change people’s lives.