In previous blog postings on Breast implant choice and high profile implants. I have stated my preference for high profile implants when doing a breast lift. As with every rule, there are always exceptions. In the case of Tubular breast deformity I prefer a moderate profile implant and I will explain the reasons why.
The tubular base has several characteristics. The most defining one is that they have a small breast base perimeter, referred to as a constricted breast base. A small breast can have a constricted breast without being a tubular breast.
A tubular breast also has a large areola in relation to the amount of breast tissue. In some cases, it appears as if the entire amount of breast tissue is behind the areola (nipple). Finally, the breast tissue tends to hang over the constricted base, so you may have a breast that hangs, even though it is quite small.
These three characteristics put together give the breast the look of a tube, or a root tuber. The correction of a Tubular breast deformity must then address all three components of the deformity.
It must enlarge the base perimeter of the breast. Given a high profile implant and a moderate profile implant of the same volume, for example 325 cc’s, the moderate profile implant has a larger base perimeter. For this reason it is better suited to correct the appearance of a constricted (smaller) base at the bottom of the tube.
As far as the areola, one must make it smaller. If you don’t, as the entire breast skin stretches to accomodate the implant the areola will expand too. There is a shortage of skin at the base, and some surgeons in the past have advocated creating a flap of skin from the breast crease and adding it to the lower pole of the breast. I don’t think that is necessary and leaves too much scarring. For the same reason of scarring I don’t like either a lollipop (Vertical) or keyhole (Inverted T) scar. These procedures remove skin from the lower pole of the breast, when you need all the skin you have. The perfect solution then is the Benelli Breast lift, or Donut mastopexy. It reduces the areola size and gets rid of the least possible amount of skin. The Crescent lift breast lift takes even less skin, but would not reduce the size of the areola (nipple).
The final element in correction of the Tubular base deformity is doing some kind of alteration to the gland tissue so there is no visible step off between the gland tissue and the implant. I have tried many things in the past, and what worked out the best for me is to score the gland tissue so the gland tissue can spread out over the implant evenly, instead of being concentrated as a lump behind the areola.
I have performed Breast augmentation to correct a patient’s tubular breasts. With her permission, here is a 4 month post op picture of the patient: