CosmeticSurgery.com Staff Report
Medically reviewed by Ivan Thomas M.D., F.A.C.S.
CONSUMER BRIEF: Experts say about one to five percent of breast augmentation patients have a condition known as" hypoplastic tubular breasts." (According to the American Society for Aesthetic Plastics Surgery, 12 percent of breast augmentations on women under 18 in 2006 were for tubular breast corrections.) The condition requires special training, attention and time for a plastic surgeon to repair. Basically, the surgeon must perform -- all at once -- a breast reduction, a breast lift and a breast augmentation.
K.T., (who asked for medical privacy,) a college sophomore in Northern California was always bothered by her small breasts. When K.T. made an appointment with San Francisco plastic surgeon Roy Kim, M.D., she was shocked to learn her tubular breasts were actually a medical deformity.
"I knew I was really flat," K.T. says. "Even though I'm only 20, my breasts sagged and I had no cleavage. I didn't want the world's largest boobs; I just did not want the ugly breasts I had."
During the beach season, K.T. usually compensated by wearing a triangle top bathing suit that covered her chest while passing over on many types of clothing styles because she just did not fit into them.
"I used to catch many people staring at my chest," she says.
In tubular breasts, early growth is restricted, resulting in unusually small, drooping and uneven breasts. In most cases, herniated tissues inside the breast push against the areola, causing it to bulge and enlarge. Due to that feature, some have unkindly nick-named the condition, "Snoopy breasts."
"One of the common signs of the tubular condition is a very narrow breast at the chest wall," says Kenneth Shestak, M.D., a professor of surgery in the division of plastic surgery at the University of Pittsburgh School of Medicine in Pittsburgh. "If a surgeon places an implant in a tubular breast, the gland sags even more, creating one very unhappy patient.
"A regular breast augmentation and an augmentation done on a tubular breast are two very different operations."
Said 20-year-old Deborah, a British blogger who wrote to a breast augmentation site: "Having tubular breasts impacted all areas of my life, the way I dressed, the way I behaved, my relationships, confidence and health. The list just goes on. When my doctors explained there was something wrong with my breasts and it had a medical name, I was incredibly relieved. Actually doing something about it was an absolute joy!"
Tubular breasts also exist in men, albeit in rare cases. But more about that later.
"From where I sit, about one in 700 women unknowingly have tubular, or tuberous, breasts," says Dr. Kim. "When we look at actual breast surgeries, we find about one tubular breast deformity in about 200 patients.
"A woman with tubular breasts usually goes into a shell, avoiding social or physical contact," says John Katzen, M.D., a board certified plastic surgeon in Los Angeles. Dr. Katzen estimates that three percent of the breast surgeries he performs involve tubular breast corrections.
"Most women with the condition say, 'Doctor, I know something is wrong with my breasts. Can you fix them?' Many ask if I have ever seen anything like it before," says Dr. Katzen.
Among the many good reasons for seeing a board certified plastic surgeon: a standard breast augmentation procedure on a tubular breast patient will only make matters worse.
While variations naturally exist among patients, tubular breasts share a few other common features in addition to a long, narrow shape. Besides large, fleshy areolas, most tuberous breasts sit too far apart, leaving the patient with an unnaturally wide cleavage. Usually, one breast is usually so much smaller, two different size breast implants are required in the operation. Even on teens and very young women, both tubular breasts sag. If all that weren't enough, the inframammary fold -- the place where the bottoms of the breasts meet the chest wall -- is usually too high, causing even more drooping.
K.T.’s uncorrected tubular breasts, left, are shown next to her augmented and repaired breasts two months after the procedure. (Photos courtesy of Roy Kim, M.D.)
For reasons largely unknown, tubular breasts are hypoplastic, meaning their development was stymied shortly after the start of development in puberty. Tubular breasts usually don't contain enough glandular tissue so women with the condition frequently have milk supply problems and may need to supplement their infants' nourishment with formula. Unfortunately, the breast implant procedure can lessen the milk supply even more, along with the probability of successful breastfeeding.
"All of these factors need to be taken into consideration by a well-trained, knowledgeable board certified plastic surgeon who has experience with the condition," says Dr. Shestak who sees in any given year 25 to 30 such patients, ranging in age from 15 to 40.
One of Dr. Shestak's patients was a depressed, extremely inhibited 21-year-old university music major with a severe tubular breast deformity. In addition, she had previous surgery on her lungs as a child and was left with additional deformities of the chest. Dr. Shestak and colleagues reconstructed her breasts, repositioned her areola to a more natural position and repaired the old damage to her chest.
"She changed into a happier, more confident person who was at ease with herself almost overnight," says Dr. Shestak who is also chief of plastic surgery at Magee Women's Hospital in Pittsburgh.
"I also recall a strikingly beautiful, highly successful advertising executive with the condition who constantly struggled with her personal life until she underwent repair and augmentation of her tubular condition," Dr. Shestak says.
Plastic surgeons who are going into the operating room to repair tubular breasts have several surgical options available.
In one of the most common procedures, the surgeon makes an incision near the nipple. Because the tuberous breast contains denser than normal tissue, some breast tissue is removed. Then, the surgeon widens the base of the breast where it meets the chest wall. He or she does that by reaching down from the opening in the areola and making a series of clockwise incisions around the breast. Imagine looking down on a prone patient, and seeing the breast as a clock; the incisions to make a tuberous breast wider are made from 8 to 4. The result is an even, round shell so the implants can be placed into smooth cups of skin.
Depending on the woman's anatomy and other factors, the implant may be placed under or over the chest muscle. Most surgeons prefer placing the implant under the chest muscles. Some make the areola smaller.
"Virtually all tubular breasts are not symmetrical and require two different sized implants," says Dr. Katzen, who then performs the typical breast lift procedure which lifts the breast and moves the areola and nipple into a higher position.
Adds Dr. Kim:
"For a tubular breast correction, a silicone implant is vastly superior. Saline implants don't look or feel as natural as silicone. When scar tissue binds to the saline implant, the implants become too hard and can lose shape or ripple over time as scar tissue attaches to them."
Other surgical procedures involve the surgeon inserting a flap of skin at the bottom of each breast to widen the base and allow more room for the implant. Still others use a tissue expander inside the breast to slowly expand it, leaving more space for the implant.
The operation is far different for men.
"In most cases of tuberous gynecomastia, where the man's narrow breast projects outward like a zucchini, the excess breast tissue is concentrated only behind the nipple and areola like a stack of quarters, instead of spreading out over the entire breast," says New York plastic surgeon Elliot Jacobs, M.D., FACS, who says he is one of two gynecomastia experts living in the United States.
The male tuberous gynecomastia surgery operation temporarily removes the nipples and areolas to make them smaller.
"Then, excess breast tissue and skin are removed, finally leaving a horizontal incision on the chest," says Dr. Jacobs. "The nipple complex is placed back on the chest as a skin graft. The usual result is a smooth, contoured, flat chest but with a scar on each side. Unfortunately, the nipple graft is also insensate-- it has no feeling."
Nonetheless, most guys with small, female-like breasts would quickly trade a few fading scars for a flatter chest that looks good in a T-shirt, insists to Dr. Jacobs.
K.T. (whose before-and-after pictures appear above), says with augmented breasts and fuller cleavage, she does not worry so much about her weight and that she feels her body looks much better and far more balanced.
"I used to be on a constant diet but now nobody stares at my chest and I feel so much more confident," K.T. says. "When I found out my breasts were deformed, I was kind of surprised but it made me feel better because the operation was needed as well as wanted.
"And I'm really glad I have silicone implants; some of my girl friends have saline which look hard and not as natural."
EDITOR'S NOTE: Our medical reviewer: Ivan Thomas, M.D., specializes in all breast procedures including tubular breast repair and augmentation. Dr. Thomas also offers a new type of abdominoplasty known as The Beverly Hills Tummy Tuck which provides the patient with a dramatically flatter abdomen, along with a significantly better-defined waistline.