Hello, I'm an 18 year old female and ever since I was about 14 I've been concerned that my breasts are tubular. However, when my nipples are erect (as pictured) they look perfectly fine in my opinion. It's almost as if the tissue gets pinched back and creates a rounder shape. But I don't have naturally erect nipples, they're quite puffy. In your professional opinion, are they tuberous? Because I'm young, do I still have a chance of developing more rounded breasts in the future?
Tubular breasts is a descriptive term that indicates certain features that are variably present to variable degrees. Some call it constricted breasts because the base of the breast is tight and as a result the breast tissue tends to herniated into the nipple causing the "puffiness" in the areola . The tuberous breast is small and often asymmetric. The difference between this scenario & small breasts is that small breasts are symmetrically smaller with respect to the circumference & center of the breast..
You appear to have constricted breasts But you do not fit all of the criteria. Your nipple may have some tendencies of a tuberous breast however your breast is fairly normal on the whole . If you look carefully, the lower slope of the breast is a straight line instead of a gentle convex curve , with the right breast more tuberous than the left. . As in tuberous breasts , which the contraction literally prevents the breast contents from bulging forward and assuming a hemispheric shaper, yours have a bit of that characteristic .Also you do have some herniation of tissue into the areola along with a tight/"constricted" lower pole of your breast. . You have to remember that breasts come in all shapes and sizes. Very few are "perfect." Your breasts are going to develop the way they will and they will continue to change as you grow, age, become pregnant, etc. As you mature there is a chance of some improvement but It is unlikely that the general breast shape will change as much as you get older
If you decide to correct this, it can be achieved through an augmentation where the inferior pole and the infra-mammary crease is released to prevent double bubble formation.. At the same time, herniated tissue behind the areola can be removed and this is done through the peri-areolar incision , and then doing some scoring on the inside of the lower pole. If only the areolar puffiness bothers you, it would be a relatively straightforward procedure to tighten the areolar area. This could typically be done under local anesthesia
if you wished.
Tuberous breasts are generally defined by the following:
• short distance from the nipple --> infra-mammary fold
• dilated and/or "prominent" areola
The issue with the tubular or tuberous breasts is that the lower aspect of the breast from nipple to breast crease is short (yours fits) and the nipple and areola are wide and allow the breasts to protrude through this area making them more prominent
• loss of rounding to the lower pole with obvious constriction
In the tuberous breast the skin of the lower half of the breast remains attached to the chest wall & does not grow with the remainder of the breast during puberty.
I am a little worried because I had a breast augmentation three weeks ago ( high profile silicone 350 CC's). they are too high , will they come down eventually? Should I consider another surgery, and if so, when? I have read that breast massages are very good to let them down, but I also read this is not recommended in texturized implants. Can you give me an advice?
Answer:
Implants may be slightly higher in the initial phase for several weeks, but they will come down if the pocket has been properly dissected. Many surgeons will use a compression band to combat this and also recommend downward massage efforts in the weeks following surgery.
It is often the case that after breast augmentation, the implants seem to be too high. Your breast size is larger now and this results in that the breast feel too high, especially with high profile implants. Without doubt, they will come down and appear more natural with time. This is objectively true as gravity takes effect and the weight of your implants settle in.
Since you are only three weeks out I would not begin to worry just yet
The native inframammary fold appears high with a short and (at least mildly) tight inferior pole. The markings on the chest wall suggest that the inferior pocket was created for proper implant positioning. Certainly at 3 weeks post-op it is common to have implants positioned high since they have not had enough time to settle into place. If smooth surface implants were placed, there is certainly a good chance that these implants would settle into a lower position over several months, with potential stretching of the of the inferior pole skin occurring afterward; and this could be enhanced by implant displacement exercises and the use of a compression band over the upper pole.
agree, your implants are too high on your chest wall. Having said that, I would be patient, the implants will "drop" or settle into place over time. I would wait at least 3 months and 6 months would be better. If the implants are still too high, than you will need to have them repositioned into a lower position.
It seems that you have a "high crease", the distance between your nipple and the inframammary crease is too short. The surgeon should have lowered your crease during the procedure, if it does not happened. I would be surprised if you do not need a secondary procedure to correct this.
Capsular Contracture ,What is the Best Way to Treat it at Home?
I would like to know if deep tissue massage regularly is the best way? using a massage machine that vibrates and pulsates at different levels regularly? also what about medicine? I appreciate any advice towards my question, thanks.
Answer:
Capsules form around breast implants within days of their placement. The capsules are basically scar tissue that surrounds the implants .The formation of scar around the breast implant is normal as a breast implant capsule.. When it is excessively thick and/or tight scar tissue around the breast implant tight it is known as a capsule contracture. We do not know why or how this happens. For a variety of reasons muscle like contractile cells can appear in the capsule wall. When they contract we see/feel a hard breast (capsular contracture) with variable degrees of surface outline distortion, from the outside the breast implant is deformed from the capsule that is progressively shrinking. That is usually seen at months or years after surgery. The longer the contracture has been present the harder it is to treat and the more aggressive the treatment/surgery that is required.
and the severity of the capsule can be assigned to one of three categories:
Category 1: Breast is more firm than usual, but not visibly different or painful
Category 2: Breast is firm and visibly different in shape or appearence
Category 3: Breast is firm, visibly different, and painful
The best way to prevent capsular contracture is to do breast massages both medially and superiorly 3x per day. You should do this for at least the first year after breast augmentation and continue it daily thereafter for the duration of the implants to minimize closure of the capsule. Massage is usually recommended immediately following the surgery and can be continued for months to years , but is absolutely no scientific evidence that it helps prevent contractures.
If the capsular contracture has only be present for a few days or weeks it may be amenable to non-surgical treatment such as deep massage. It really depends on how long you have noticed it…If it is just starting, then I have had patients have success with alternating deep massage. Home massage, however will not likely make a difference if the capsule is already significant or contracted.
Endermologie (the combination of rollers and suction pressure applied to the skin surface) can be a good way to get the massage movement deep enough under the skin to stretch and soften the capsule.
Singulair and Vit E can be used but likely have very little effect. Singulair is a widely used asthma medication that can sometimes help. This is an off label use of this medicine. but this does not necessarily work in every patient. Time likely will either help relax the capsule somewhat or keep it relatively unchanged
There is nothing you can do to treat established capsular contracture at home. Overly aggressive pressure maneuvers may cause damage to your implants. Finally surgery is an option to correct this by removing the capsule entirely or releasing it in areas to accommodate the implant.
BREAST LIFT
Many women, particularly those who have had children, will notice that their breast tissue will droop and “deflate” following breast-feeding. This phenomenon is not limited to mothers, however, as changes in weight as well as hormone fluctuations can cause these same issues. Some women, in fact, are born with breasts that may not be as “perky” as they would like. Many patients who complain of this breast deflation, or “breast ptosis” in medical terms, benefit from an elevation of the breast tissue, known as a breast lift or
mastopexy
Breast lift achieves the following:
Brings the breast to a more attractive position
Reduces the size of Areola
Helps the breast to become more perky .
There are several ways to go about providing true or apparent lifting of the breast tissue.
Wise Pattern Breast Lift:
The standard and effective technique to lift the breast is known as a Wise pattern mastopexy Classically, breast lifts were done through a pattern similar to classical breast reductions, resulting in a scar around the nipple, down the center, and underneath of the breast, which you can think of as an anchor type of configuration. While this operation works well for many patients, it provides a lot of scarring, and can, in certain patients, give rise to a breast that lacks proper projection. Efforts were subsequently made to try and improve the deficiencies of this operation, and a plastic surgeon named Dr. Lejour developed a breast surgery that eliminated the scar under the breast and improved postoperative breast form. This is called the vertical mastopexy.
Vertical Breast Lift:
The vertical mastopexy has become one of the mainstays of the breast lift here in my practice. This operation works well for most women who do not have massive breasts, and allows some degree in reduction of the size of the breast if this is what you are looking for. Alternatively, the vertical breast lift can be combined with a breast implant in order to increase the breast size. In either situation, the scars from this vertical breast lift look like a lollipop- around the nipple and down the center of the breast. The concept behind the vertical mastopexy is the rearrangement of the breast tissue itself to a higher position, rather than creating a skin sling to suspend the breast tissue. This breast tissue rearrangement is felt to give a more pleasing shape and a longer lasting result.
Benelli Breast Lift:
For those patients that require only minimal lifting and who may be adverse to the longitudinal scar of the vertical breast lift, an alternative may be what is called a purse-string, or Benelli mastopexy. This operation is performed by resection of an eccentric area of skin around the nipple, which can be thought of as an oval shaped doughnut where more skin is resected above the nipple than below it. Following a small amount of dissection in the breast tissue to strengthen the breast lift, this incision is closed with a purse-string suture that “cinches” the breast envelope centrally and upward to provide a lift. The scar resulting from this breast lift operation is only around the nipple along the transition between the pigmented areola and the skin of the breast. This operation does have the limitation of lifting the breast tissue only one to two centimeters, however, and so only patients with minimal ptosis may be candidates for this procedure.
The Use of Breast Implants With Your Breast Lift:
With any breast lift procedure, the result may be enhanced with the ancillary use of a breast implant to increase volume and fullness.
A breast implant may be used with the classic breast lift, the vertical breast lift, or the Benelli breast lift procedure. Placement of large breast implants during these procedures is discouraged because of the following safety issue. When dissection of the breast tissue is performed in order to achieve a higher and more youthful appearance, careful attention must be given to the blood flow to the breast tissue that is being rearranged. Large implants placed under this dissection can put undue tension on the lifted breast tissue, causing compromise of the nipple. breast implants that are not excessively large may be used at the time of your initial breast lift operation as a single procedure. Discussion regarding your individual anatomy and expectations will allow a plastic surgery plan to be tailored to your specific situation. The quality of scar can also be improved if your surgeon is committed and places deep suture to avoid widening of the scars
Question:
There are 10 years after my breast aumentation surgery with prothesis and stick out more. They feel somewhat harder, but is this the implant or capsular contracture? How does a doctor determine if a patient has this problem?
Answer:
Increased firmness 10 years after breast implant surgery is certainly a capsular contracture. The implants themselves do not get firm. Capsular contracture is when the tissue surrounding the implant gets more dense and tightens arounds the implant squeezing it. If it tightens enough, the implant will get very firm and become shaped like a ball. Remember that the smallest space an object can occupy is a perfect sphere, and if the scar tightens enough, the implant will become a sphere. And, further tightening can even become painful.
There are four grades of breast capsular contracture - The grading is as follows ( according to the Baker system ) :
• Grade I the breast is normally soft and looks natural
• Grade II the breast is a little firm but looks normal
• Grade III the breast is firm and looks abnormal
• Grade IV the breast is hard, painful, and looks abnormal
If you are a Grade 2, I would do nothing. Grade 3, but only mildly distorted and you may need replacement of the implant and removal of the surrounding scar capsule(called a capsulectomy). Capsule contracture is the most common complication of an augmentation mammoplasty.
Some patients have had some softening of the encapsulation using the medication Singular, which is an anti-leucotriene. Add an anti-prostaglandin to that, such as Aleve, and you may have some relief natural Vitamin E complex
The following techniques have been employed to fight capsular contracture:
1. submuscular breast implant placement
2. using textured implants
3. limiting handling of the implants and skin contact prior to insertion
4. irrigation with triple-antibiotic solutions
the study examined saline vs. silicone capsular contracture rates , actually found silicone to be higher but this was likely secondary to the fact that a RUPTURED silicone implant causes much more of an immune response and is likely to cause capsular contracture. However the most reliable and common way to treat capular contracture is to remove the capsule and replace the implant
The causes have not conclusively been determined although some things that increase capsular contracture are: 1) Infection, 2) Hematoma (collection of blood around the implant), 3) History of breast radiation, and 4) History of previous capsular contracture .It is believed that capsular contracture is primarily a response to the presence of low-virulence or non-virulent bacteria (i.e. not the kind that generally produce an actual infection, with redness/tenderness/fever etc) that adhere to the implant surface on the day of surgery, and which over weeks and months following surgery stimulate the cells that make collagen (called fibroblasts) to make more collagen - thickening the capsule and stimulating it to contract and tighten around the implant. It is not an actual infection; there are no symptoms that this is going on, and taking antibiotics will not prevent the process or reverse it. The source of these non-virulent bacteria is thought to be the patient's skin, or the ductal systems of the breast that lead to the nipple, as both are normally colonized with bacteria.
The older implants are known to have greater gel bleed which allows smaller particle size silicone molecules to bleed out from the implant shell over time. This is though to incite a low grade inflammatory reaction and potentially contribute to capsular contracture.
A capsular contracture is diagnosed by physical exam and symptoms – . If the implant is firm and does not move around or starts to ride up on the chest more so on one side than the other, then more than likely you have it. imaging can show scar but not contracture . Encapsulated implants will feel very distinct from the surrounding breast tissue, are usually firmly attached to the chest wall, and the breast tissue will sometimes hang off the implants. Often times they may feel painful to the touch as well, which can occur in more advanced forms of this condition. You can try to massage the implants to relieve some of these signs/symptoms
Capsular contracture can occur on one or both sides, and while it can develop early (weeks) or late (years) after a breast augmentation surgery, in the vast majority of cases it is evident fairly early following the procedure. So the good news is that once you are six to 12 months out from your surgery, if your augmented breasts are soft and supple then they are likely to stay that way for the long term.
The more difficult decision is what to do. If the contracture does not bother you, it may be best to adopt a wait and see. Surgical options typically involve replacing the implants and either removing the capsule itself, or changing the position of the implant.
1. If it doesn't bother you, capsular contracture is not medically worrisome, and you could consider doing nothing if the process is stable.
2. If it is mild and early but bothers you, certain medications (Singulair, Accolate, Vitamin E) show promise in reducing or at least preventing progression of capsular contracture.
3. If it is moderate to severe, you may wish to consider surgery to loosen or remove part or all of the capsule (capsulectomy or capsulotomy) with implant replacement.
I would encourage you to perform breast implant excercises to prevent or minimize ongoing contracture.
