Dr. Joel Aronowitz — Tubular Breast Correction Surgery with Dr. A

Dr. Joel Aronowitz: “Hi everyone, and welcome back to the channel. Today, we have a case of a tubular breast deformity. This is a young woman who had a very significant weight loss as well as childbearing, and she lost virtually all of the volume in her breast. But in addition, the breast has a shape issue called a tubular breast deformity, also known as a tuberous breast deformity or a Snoopy nose-shaped breast. This is caused by a fibrous layer beneath the skin. It’s a layer that constricts the growth of the breast with puberty and with weight gain or with pregnancy. And that layer constricts all of the growth of the breast with the exception of the nipple-areola. So, that entire nipple area does not have that fibrous layer; so therefore, the nipple can be the most projecting part of the breast. And that’s what gives the breast its typical shape, but in the case of a tuberous breast, that layer is too tight.

So if it’s too tight in the lower pole, that is below the nipple, then you’ll have a breast that kind of flops over too quickly and a very constricted distance between the nipple and the inframammary fold. If it’s too tight immediately toward the sternum, then it will bring the nipples closer together and be kind of a cross-eyed looking breast, if you will, where the nipples are pointing toward each other.

I hope you enjoyed this case. I want to express appreciation to the patient for allowing us to share her surgery with you. Now, we’ve dissected a pocket for the implant, and it’s going to be, we’ve gone through the areola here, and the pocket is all the way behind the breast, and the fold of the breast is right here, but we’re going to lower the fold a little bit so that this distance can be a more normal distance between the nipple and the inframammary fold. And for women, most women will have a distance of four to five centimeters between the lower part of the areola and the fold, or about six, seven centimeters between the nipple itself and the fold. And in her case, as I showed you preoperatively, it’s only about one, one and a half centimeters.

So here, you can see where her breast wants to fold right here. So, we’re going to put in an implant, and then you’ll see that this tissue on her chest becomes recruited onto the breast so that the breast has extra skin there where it needs it. And also, on the inside, I’ve released the fibrous layer that I described earlier so that it can expand.

Here is my breast implant. This is saline, and I’m going to roll it into a little roll here so that it will slip into my incision more readily. The implant is happy in there. ‘Are you happy, little implant?’ When you suck out that last bit of air in the implant so it’s completely deflated, we want to fill it just with the saline; we don’t want any liquid in there. And now we’ll start to fill it up. And this will be 50 cc. So, I’ll show you in a moment what this looks like completely filled up.

So now, you can see the incision we partially closed. You can see the implant now inflated at 450. And basically, that implant is going to fill out down here so that the lower pole of the breast is larger. We have a bigger distance here, so we have less of that constriction because if it’s constricted, it’ll do this. The upper pole will stretch abnormally, and the lower pole won’t. So, we want this lower pole distance to be greater so that this will end up stretching more, and it’ll be a normal sagging of the breast over time.

Now, let’s review what we’ve done. We start with a tubular breast, and the breast is very deflated because this patient had lost a lot of weight. We put an implant behind the breast and released the fibrous tissue so that the breast envelope could expand, and we even lowered the fold a little bit, which we usually don’t do, so that the distance between the nipple and the fold was a healthier length of about 5 centimeters instead of very constricted. Then we did a donut mastopexy. We took a donut of skin out around the nipple and constricted it with a purse-string suture. So, this is our result, and you’ll see that the implant’s a fairly big implant. It creates more of a bulge up here, but with time, this distance is going to stretch out and give her a better shape and allow that nipple to rotate superiorly.

Well, I hope you enjoyed this surgery. We’ll try to post some follow-up pictures after a while, with the patient’s permission. Sorry about the novel studio here, but I’m traveling, and I wanted to get this video posted for you. I hope you enjoyed this example of breast augmentation for correction of the tuberous breast. So anyway, tuberous or tubular breast deformity, and this is corrected with a special type of breast augmentation. Hope you enjoyed it. If I didn’t explain this properly, please leave a question below, or any comments you have about the video for me. Okay, later more from Aronowitzland.” — Dr. Joel Aronowitz

Originally published at https://drjoelaronowitzmd.blogspot.com/ on November 4, 2023