Tubular Breast Surgery

Tubular breast is a condition in which the breast does not resemble a hemisphere but instead grows forward into a tubular shape. Nipples and areolas are usually enlarged in such cases. The development of tubular breasts is genetically determined.

The fascia (connective tissue sheath) can be too rigid, preventing the gland from spreading evenly and forming a hemispherical shape. In some cases, the breast tissue itself is too dense, which also makes it difficult to form a rounded contour. As a result, the breast begins to grow forward and stretches into a tube.

Anatomical Features of Tubular Breasts

• Typical characteristics include:
• Hypoplasia (underdevelopment) of the breast
• Abnormally high inframammary fold
• Areolar hernias
• Enlarged areola and nipple, usually located in the lower part of the breast
• Wide spacing between the breasts
• Breast asymmetry

A woman may present with one, several, or all of these features, as tubular deformity can appear in varying degrees. It may be barely noticeable — with slightly upward-pointing glands and a downward-tilted nipple — or very pronounced, when the breast base is too small and the poorly developed areola with an areolar hernia is disproportionately large, giving the breast a “mushroom cap” appearance.

Tubular deformity is relatively common. It is not dangerous to health and, in most cases, does not interfere with breastfeeding. However, it can significantly affect self-esteem.^{Cleveland Clinic}

Specifics of Breast Augmentation in Tubular Breasts

Tubular breast shape complicates augmentation surgery. Correction cannot be achieved with implants alone because:

The dense fascia in tubular breasts prevents the gland from properly expanding over the implant.

The lower pole is almost absent (very short), so if only an implant is placed, the nipple may tilt downward unattractively.

Therefore, correction requires a combination of surgical steps:

1. Release and redistribution of gland and fascia

The breast fascia is incised in several places to release it and expand the area. Then, the gland is dissected, and breast tissue is redistributed. To achieve rounded contours, the inframammary fold needs to be lowered.

2. Lipofilling

Shape correction is ideally complemented by fat grafting. By adding autologous fat, the lower pole of the breast can be filled out.

Lipofilling alone cannot dramatically increase breast size (usually 0.5–1 size, rarely up to 1.5). If the patient wants more significant enlargement and anatomy allows, lipofilling can be combined with implants.

If the tubular breast is already large and requires a lift, a mastopexy with implants and lowering of the inframammary fold can be performed. In such cases, lipofilling may not be necessary.

If the anatomy permits a one-stage result, the surgeon may recommend a combined procedure (implants + lipofilling). If this is not possible, correction is done in two stages: first lipofilling, then after about 4 months, when tissues have stretched and changed shape, implants are placed.

Surgical Approaches (Incisions)

All access routes may be used depending on the patient’s initial anatomy. If tubular deformity is pronounced, the incision is usually made along the lower edge of the areola.

The inframammary approach is chosen when the fold needs to be lowered. Doing this through the areola is undesirable, as the new fold must be fixed securely to prevent implant displacement.

If the patient wants the nipple positioned higher, it needs to be moved. The decision on technique depends, among other factors, on the chosen implant.

If a lift is required, the incision may be made around the areola, vertically, and along the inframammary fold. Thanks to the T-shaped lift, tissues can be reshaped and redistributed to achieve the most aesthetically pleasing result. The tension after surgery is distributed across three scars, which reduces the load on each one and increases the chance of fine scarring.

Other incision types in tubular breast correction limit results: neither periareolar nor vertical lifts allow proper work with the lower pole.

If both ptosis and tubular deformity are present, and the patient does not want additional scars (other than around the areola), the surgeon must explain the risks — possible wound separation, unusual breast shape, or distorted areola.

Recovery and Breastfeeding Possibilities

Tubular breast correction surgery is more invasive because the gland itself is dissected (in standard augmentation, the gland is usually not affected). However, this does not significantly affect recovery time, swelling, or bruising.

If milk ducts are not damaged during the surgery, breastfeeding remains possible in the future. If a duct is caught in the scarring zone, breastfeeding is likely to become impossible.