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Your ‘puffy nipples’ may be a result of a mild tuberous breast deformity. It occurs because of a constrictive ring that acts to restrict your breast as it develops and increases in size on your chest wall. The breast gets larger and larger but it can’t get through the band. The breast continues to grow and get larger and keeps on trying and pushing to get through the ring. Eventually enough force builds up and the breast is able to ‘pop’ through the ring but now there is too much tissue that escapes through the band and it ‘poofs up’. To correct this deformity you can undergo a breast augmentation.

There is a spectrum for so many things in medicine and tuberous breasts are another example of such a spectrum. If you do have tuberous breasts you will also find a high breast fold and a shorter distance from your fold to under your areola, and wide cleavage. It is a spectrum because it occurs as your breasts develop and therefore happens to more or less degrees.

I think there are a few things to know about Tuberous breasts: first off you can be helped! Sometimes the term Tuberous Breasts seems to add such a heavy weight to patient’s shoulders but it doesn’t have to. Patients can look significantly better and can enjoy a much rounder shape after undergoing a breast augmentation and a concentric mastopexy.

There are a few caveats to know; first the spacing between your breasts cannot be changed, as moving your breasts closer together would be like trying to move your eyes closer together—but your cleavage will improve as you will have volume in the medial, or inside part of your breast. So you will have an improvement in shape, volume and cleavage with an implant. (A word about cleavage: while the ultimate goal always seems to be looking like a Dallas Cowboys cheerleader with very close cleavage there are many, many types of cleavage that look pretty and a little wider space between the breasts can still look pretty with an implant to give volume and it can certainly look more natural).

A second caveat—tuberous breasts tend to recur with time. This is not something frequently discussed, but I have seen it many times and now tell all of my patients with tuberous breasts that their shape will try to return to some degree—that’s important to realize— but with droop it will return and they will need another surgery to correct it again in the future.

For example, I just saw a new patient the other day who had a breast lift and augmentation three years ago with another surgeon and she was very distraught that her breasts “looked exactly like they did before” her surgery. I looked at her before photos and she indeed had tuberous breasts. Her photos immediately after her surgery looked good and her surgeon did a very nice job. But now she had some droop as happens with children and time, and you could see one of her breasts in particular had a more triangular shape as it had before her lift with implants. What had happened is that her breast had dropped and fallen off of the implant, and the implant was no longer in a position to give the breast a rounder shape—so the breast returned to its previous shape. (I liken this to a pleat in a pant and you can make it better by ironing it, but over time the pleat still wants to come back; as long as the iron is on it the pleat remains at bay). So go into the operation with realistic expectations that your breasts will look much better: more fuller, rounder, prettier and you will have better cleavage although your breasts won’t be as close together as you may want, but you will be happy and keep in mind that you will likely need to have a revision in the future although the second surgery will be a much more minor surgery than the first.

Dr. William Miami

Author Dr. William Miami

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