February 16th, 2011 Dr. Mele
Tubular breast deformity is a common, congenital breast abnormality found in both women and men. In men, the treatment is straight forward (see the bottom of this article). In women, however, additional aesthetic norms come into play, making the repair more complex.
Tubular Breast Deformity in Women
Tubular breast deformity is known by many names:
- Tubular breast deformity
- Tuberous breast deformity
- Snoopy Nose or Snoopy’s Nose deformity
- Constricted breast deformity
Women with mild constriction often come to see me to simply increase the size of their breast, not aware of the diagnosis. Women with more severe deformity, however, are often reluctant to show their breasts to others, and want to improve the size and the shape of their breasts. Correcting these types of problems is more challenging, but at the same time, quite rewarding.
Mild tubular breast deformity with constricted base was corrected with sub-pectoral breast augmentation (behind the muscle) and internal release (no lift needed)
Tubular Breast Abnormality is a Congenital Breast Deformity
While present at birth, the full extent of the tubular breast deformity is often not appreciated until puberty. This is when the breasts normally develop, and the full extend of abnormalities are revealed. While women with tubular breasts have smaller than average sized breasts, not all small breasts are tubular breasts. While the extent to which the deformities manifest can vary widely, several specific abnormalities are present.
Signs and Presentation of Tubular Breast Abnormality
Besides smaller size, the main components of the tubular breast are a constricted base and a tubular shape to the breast. This can be exacerbated by herniation of the breast tissue into the areola, causing “puffy nipples”. Technically, the nipple is not affected, but the areola, the colored skin around the nipple, may project out from the breast mound. The overall effect is an elongated or tubular shape to the breast. The true tubular shape is most noticeable in more severe cases.
The colloquial name for tuberous breasts is the Snoopy Nose or Snoopy’s Nose deformity. Snoopy is Charlie Brown’s white beagle of Peanuts fame. Picture the front of Snoopy’s muzzle. If you are not familiar with Snoopy click the link above. His white face represents the breast mound, his black nose sits like a ball on the end, and represents the herniated breast tissue filling the areola.
Treatment of the Tuberous Breasts
As mentioned above, tubular breasts tend to not fully develop. Often patients with tubular breasts desire breast augmentation to increase the size of their breasts. For mild tubular breast deformity, a breast implant may be sufficient treatment. When the breasts are more tubular, additional maneuvers are necessary to provide an enhanced result.
If the areola is overly full, a periareolar lift can reduce the puffy nipples, and prevent the breast tissue from herniating. Unlike for men, the breast tissue is not usually removed, just pushed back into its normal anatomical position. The constricted base seen with tuberous breasts also tends to shorten the distance between the areola and the base of the breast. The lift has the additional benefit of moving the areola higher on the breast, helping to center the nipple on the breast mound.
Moderate tubular breast deformity with constricted base, elongated breast and mild areolar breast tissue herniation, best seen in right breast (your left). Both size and shape were corrected with breast augmentation and peri-areolar lifts.
Traditionally, tubular breast were treated with breast implants placed in front of the muscle. With a periareolar lift, it usually possible to place the implant behind the muscle. This gives a more natural appearing breast mound, and makes it easier to perform mammography in the future. While silicone and saline breast implants can both give good looking results, for smaller breast, a silicone gel implant may give a better feeling result. It is important to discuss the pro’s and con’s of each option with your Board Certified Plastic Surgeon.
Tubular Breast Deformity in Men
In men, tubular breast deformity presents as an overly full areola or “puffy nipples”. Since men like flat chests, tuberous breasts are easily treated in with resection of the excess tissue. The procedure is similar to that used for Gynecomastia. A small “smiley-face” incision is made from 4 to 8 o’clock around the lower edge of the areola, and the excess glandular tissue is removed. The procedure provides a smoother contour, and a quick recovery.
Information on Tubular Breasts
More information on tubular breasts is available on the breast abnormalities page of my specialty breast site under Congenital Abnormalities – Tuberous or Tubular Breasts, and the Snoopy Nose Deformity. Tubular Breast Augmentation Before and After Pictures are also available in my main web site. The best information, however, is only available in person. If you would like to schedule a consultation appointment in my Walnut Creek Cosmetic Surgery office, please give me a call at (925) 943-6353, or use the contact form in the column to the left.
November 25th, 2010 Dr. Mele
San Francisco plastic surgery patients have an extensive new local resource encompassing all aspects of cosmetic breast enhancement surgery. I have consolidated my years of experience, and the common questions that my patients ask, to create a site that is both informative and understandable. If you are considering cosmetic breast surgery, SanFranciscoBreast.com is a comprehensive collection of consumer information.
The web site is illustrated with videos and before and after pictures. The list of topics covered is long and includes:
Breast Augmentation Lift
Breast Augmentation Revision
Gynecomastia Reduction – Breast Reduction for Men
Specialty Breast Procedures – Correction of Other Breast Abnormalities
SanFranciscoBreast.com is a specialty site dedicated to all aspects cosmetic breast surgery. Since the site is focused only on the breast, it gives me the opportunity to describe each procedure in detail, and to provide you with specific information to help you make an informed decision.
September 11th, 2009 Dr. Mele
Walnut Creek Plastic Surgeon (San Francisco Bay Area, East Bay) Joseph A. Mele, III, MD, FACS, will be appearing on KRON channel 4′s, Body Beautiful this Monday, September 14, 2009, at 11:00 AM.
KRON4′s Body Beautiful, is a weekly news show hosted by News Anchor Vivki Liviakis. It originates right here in San Francisco and is know through out the Bay Area for its coverage of the lastest trends in cosmetic plastic surgery.
This week’s topic will be breast augmentation, specifically breast implant revision surgery. Information about breast augmentation and the most common reasons for breast implant revision will be presented. Topics will include, choosing the best breast implant size, breast implant deflation, capsular contracture, dealing with breast asymmetry, and how to decrease your risk of needing breast augmentation revision surgery.
If you have questions that you would like me to answer on air, please send them via the contact form on this page. Please do mention that you would like me to answer your question on Body Beautiful, otherwise all inquiries are kept confidential. Alternatively, you can send your questions directly to KRON4 via the Body Beautiful web page. You can also phone into the studio while we are on the air, and get your questions answered live.
Previous shows discussing breast augmentation, tummy tucks, liposuction, eyelids surgery and many other cosmetic plastic surgery procedures can be found on my website in the DrMele.com Video Gallery
A unique aspect of Body Beautiful is it live broadcast live. Broadcasting live allows for more a more dynamic and interactive presentation. A segment of the show will be dedicated to viewer questions. So be sure to call in.
September 7th, 2009 Dr. Mele
Breast augmentation has become the most frequently performed cosmetic plastic surgery procedure. As a result, breast augmentation revision has also increased. This topic has been discussed previously under breast asymmetry and capuslar contracture. There are many reasons for breast implant revision surgery San Francisco; they can be divided into three main groups.
- Breast implant size – Perhaps the most common reason for breast implant revision surgery. The breast implant and pocket may both be fine, but there is a desire to change the size of the breast augmentation. By far, the most common change is to place larger breast implants, but reducing breast implant size and correcting asymmetry for size also are included in this category.
- Breast implant leak – Failure of the implant, and loss of the filling volume is another common reason for breast implant revision. Saline filled breast implants rapidly lose volume and it is clear that there is a problem. Silicone gel filled breast implants may require an MRI to determine if there is a leak. Regardless of the type of implant, if there is a leak, it needs to be replaced.
- Pocket problems – The pocket around the implant is normally lined with a thin soft scar. When the scar becomes too thick or too tight this is called capsular contracture. In its advanced stages, capsular contracture can lead to a firm, tight, immobile breast, which in severe cases becomes painful. On the other hand, if the scar is too soft and loose, the implants can move too much. This can lead to implants that are bottoming out (too low) or the implants may fall to the side when laying down (like natural large breast do).
Here is another example of breast augmentation revision surgery bay area. This patient presented to my Walnut Creek plastic surgery office. Overall, she was happy that she had breast implants, but she had several aspects that she wanted improved.
- Her bra would ride up onto the lower pole of her breast with exercise.
- Her implants had bottomed out.
- Her breast implants were asymmetric (more bottoming on the right).
- Her implants were a little small still.
- Her nipples were too prominent, noticed more after her primary breast augmentation.
- Her nipples were asymmetric.
The following procedures were discussed:
- Capsulorrhaphy – literally means capsule tightening. The lower pole of the capsule is closed to lift the implant higher on the chest. Capsulorrhaphy is also performed to move implants out of the armpits. Larger implants and weaker soft tissues increase the risk of implant malposition, and recurrence of the problem.
- Creation of an New Inframammary Fold (IMF) – This is a difficult procedure to get right, and it is worth finding a Board Certified Plastic Surgeon who has experience with this type of correction. The IMF is purposefully formed slightly higher than the desired result as there is almost always some stretching again after surgery. This procedure and capsulorrhaphy can both improve asymmetry. A defined IMF is important to keep the bra in the correct position and to allow the bra to support the breast properly.
- Breast Implant Exchange – Whenever breast augmentation revision is performed, it is worth considering whether to replace the implants. Implant volumes are most commonly increased during breast revision surgery. Sometimes the volumes are reduced and sometimes the volumes are adjusted to help compensate for asymmetry. The implants can also be exchanged between saline and silicone gel. As is often the case, a slightly larger implant was desired. Larger implants can increase the risk of bottoming out. Smaller implants will increase the reliability of the capsulorrhaphy and IMF repairs. Smaller implants are lighter, and less weight means a better chance for long term correction.
- Nipple Reduction – Generous nipples can be reduced in size. The scar lies in the crease at the base of the nipple and is very difficult to see.
- Periareaolar Breast Lift – The periareolar scar can be used to move the nipple/areaolar complex (nipple and the dark skin around it) in any direction. As with a breast lift, the scar goes around the areola. In this case, the right nipple is significantly higher than the left; however, since the patient was not really bothered by her nipple position, it was not fixed.
Breast Augmentation Revision with Nipple Reduction - Before (left) and After (right)
The previous implants were removed, a capsulorraphy was performed, additional work was done internally to form a new IMF, and new implants where placed via a periareolar scar (from 4 to 8 o’clock). The volume was increased from 300 to 350 cc’s using saline filled implants. In addition, the nipples were reduced with an incision that runs around its base. The nipple is still high on the right, and could be improved by further raising the breast implants. However, for the sake of the left breast, it is better to keep the implants in their current position. While this leaves the right nipple high, it avoids creating a low (sagging looking) nipple on the left.
Notice the improvement of the angle at the bottom of the breasts. It is no surprise that the bra was ridding up onto the breasts before surgery. After recreation of the IMF, it is higher, smooth and well defined.
August 24th, 2009 Dr. Mele
Breast asymmetry is more the rule than the exception, and there are many ways in which breasts can be uneven. Size, shape and location all come into play. Asymmetry may effect the entire breast mound (see previous post) or just the nipples. Normally, the differences are small; however, as the magnitude of breast asymmetry increases, so does the desire for correction.
In my San Francisco Bay Area (Walnut Creek) cosmetic plastic surgery practice, I measure the differences between the breasts both subjectively and objectively every day. Small differences frequently go unnoticed. Often, asymmetry is first noted in the consultation for breast augmentation. When the difference is obvious, however, breast asymmetry can be the driving force toward seeking consultation with a Board Certified Plastic Surgeon.
This post is focussed primarily on areola asymmetry (the darker skin around the nipple) and nipple asymmetry (the raised part in the middle). Look for a post on breast asymmetry (the breast mound itself), including breast implant asymmetry, in the very near future.
One of the most common nipple asymmetries is caused by inversion (retraction) of the nipples. Inverted nipples can occur on one or both sides. Inverted nipples and even bifid (split or duplicated) nipples can be treated with minor surgery.
Before correction the nipple and part of the areola are hidden.
Inverted nipples are caused by short mammary ducts that pull the nipple inside the breast tissue. In the most pronounced forms even the areola maybe hidden. The scar for inverted nipple correction is normally hidden in the fold beneath the nipple. Since correction involves releasing the tight ducts, correction may interfere with the ability to breast feed, and this should be discussed with your plastic surgeon prior to surgery.
After correction the relatively large nipple can now be seen.
The size and shape of the nipple can also be adjusted.
Close-up of breast showing appearance of nipple enlargement after pregnancy.
Overly large nipples can be reduced in length and girth. In general, it is easier to reduce a large nipple than to enlarge a small one. Nipple reconstruction is performed after a mastectomy when the nipple is absent. With nipple reconstruction, especially when the breast has received radiation, the most difficult aspect is creating and maintaining nipple projection.
Close-up of breast showing appearance of nipple after nipple reduction.
There are times when the nipples are normally formed, but their location on the breast is asymmetric or they are just too low. Modest changes in nipple location can be improved with a periareolar approach. Several centimeters of motion can be safely accomplished with this method. The same periareolar technique can also be used for areolar reduction or to correct the overly full areola, as seen with a tubular breast deformity.
Larger asymmetries may require surgery similar to a breast lift. Formal breast lifts allow the larger movement of the nipples, and reshaping of the entire breast mound. See the previous San Francisco Plastic Surgery Blog posting by clicking here Breast Mound Asymmetry San Francisco: Breast Mound, Breast Implants. There are many types of lifts, and each has its own pros and cons. The art of Plastic Surgery is choosing the best approach for each individual San Francisco breast asymmetry patient. This will be the topic of a future posting.