Tubular Breast Treatment

Tubular breast deformity is caused by a constricting ring at the base of the breast. When the breast develops, it is unable to grow towards the chest and actually herniates into the nipple area. The treatment options for tubular breast treatment are all surgical because a surgeon has to restore volume and get rid of the herniation through the nipple complex to achieve a full correction. Depending on the severity of the deformity, it can be done with a combination of implants as well as restructuring or reshaping the breast tissue itself.

DEFORMITY DEGREES

Once the misshapen breasts are created, there are varying degrees of deformity:

1. If it is just confined to the lower medial quadrant, it is type 1.

2. If it involves both lower quadrants which are inner and outer or medial and lateral, it is type 2.

3. If it is deficient in all areas of the breast, it is a type 3.

These issues are all cosmetic in appearance and not covered by insurance. This leads young women to not get treated because they cannot afford the treatment. It is a timing issue as well as a financial constraints situation.

TREATMENT OPTIONS

The most common treatment is to make an incision around the areola and this is known as the periareolar incision. As the doctor removes excess skin, he can go beneath and behind the breast to make a breast flap that unfolds from the top to the bottom and essentially creates breast tissue where there was no breast tissue. The surgeon essentially goes behind the breast, between the chest muscle and the breast tissue, and dissects a portion of the superior breast tissue. It is folded down almost like pulling a curtain down. The doctor then sews that to the bottom and puts the breast implant behind this to create the lower portion of the breast tissue that has been absent due to its lack of development.

If a patient has almost no lower pole but does have tissue, the doctor can go behind the breast in the upper quadrant to take a portion of that breast tissue and fold it down to recreate the lower portion of the breast. Implants are then added to provide the volume to match the other side which had to be addressed as well. A combination of implants and breast tissue rearrangement will treat most of these situations.

If they are really small deformities, the surgeon can use fat grafting. Fat grafting is borrowing fat from another area of the body using small liposuction cannulas and then processing that and re-injecting it into the area to be treated.

LIMITATIONS

Patients who are really maldeveloped on one side while partially developed on the other, and also have children, are much harder to treat. The reason they are hard to treat is because the tissue on the side that never developed is very tight versus the side that partially developed that has been stretched out with pregnancy. The tissue dynamics are different for the patient so there is skin that needs to be addressed differently on either side.

It is rare to take someone with a severe deformity on one side and a moderate deformity on the other side and get them to exactly match. In cases like this, the surgeon does almost a full correction with different techniques for each side of the breast. The patient might end up with a slight asymmetry of the areola just because of the factors involved in the surgery.

BREASTFEEDING

Having the procedure before pregnancy typically will not affect breastfeeding later on in life. The tissue rearrangement could be an issue but a patient who essentially had no breast tissue is not going to breastfeed anyway.

MATCHING THE BREASTS

Once someone is deemed a candidate for surgery, the surgeon uses 3D imaging to take their pictures. The photos are put into a computer software program to give the patient an idea of what they will look like with implants.

There are a few different options regarding sizes of implants. The doctor puts in a temporary sizer to help guide the choice on how big an implant to use. Once the size is decided on, the tissue is rearranged over that and then sutured into position to make sure the areola is the appropriate size. Finally, the pocket is closed on the more significantly misshapen or malformed side as the surgeon attempts to match the more normal side to create an asymmetric pair of breasts.

The surgeon starts with the more misshaped breast shape first and tries to make it as appropriate as possible before working on the one that is less malformed.

RECOVERY

In terms of recovery, it is the same as a breast lift with augmentation since that is essentially what is happening. It is six weeks with some swelling as well.

RESULTS

The results of the procedure are permanent since the breast cannot go back to its original shape. Once the surgeon releases the band that is causing the constriction and changes the configuration of the breast tissue, he reshapes it and adds the implant to achieve the results.

FINAL THOUGHTS

It is important that women, especially young women, identify the problem early and are seen and examined by a board-certified plastic surgeon. They need to be given options and a plan for treatment so they will not have these issues for significant periods of their life. Things are still costly because implants are expensive. Once again, they are not typically covered by insurance unless they are combined with other congenital deformities. For the most part, insurance is not going to cover a small misshapen breast since it is not considered a medically necessary procedure.

Written by Cosmetic Town Editorial Team- MA

Based on an exclusive interview with Robert Whitfield, MD in Austin, TX