The tuberous breast was developed to a high grade of deformity, with severe elevation of the inframammary crease and strong constriction ring, pretty much tubular and conical shape, enlarged areolas with herniation and empty chest around the constricted base of the breast mounds.
The patient received Dr. Nogueira's four flaps personal technique of tuberous mammaplasty to treat the tubular gland, make it rounder and decompress the breast, lowering the submammary crease to an optimal level and preparation to host the prostheses to rebuild the absent lower breast pole.
Due to the particularities of the case and in order to prevent visible rippling of the implants due to insufficient gel cohesiveness, the patient opted for ultracohesive gel filled implants which provide the highest grade of gel stability from them all in the market thanks to their molecular linking effect, anatomical shaped and macrotextured, placed in the minimally invasive and non aggressive safe subfascial pocket, the technique of choice to prevent complications and bad results.
The remarkable breast asymmetry was managed using different bases, heights and projection in the nominal reference dimensions of the mammary prostheses.
This case exemplifies the absolute need for the surgeon to plan the surgery correctly aiming to obtain the best possible centricity of the nipples with regard to the breast implants, since otherwise there would be a grotesque deformity of cross eyed breasts, even if the price is to leave an empty cleavage; nothing justifies sacrificing the centricity of the nipples within the breast mound, not even the fullness of the cleavage.
In other words, breast augmentation is simply an augmentation of the breast, an enhancement, a breast enlargement, wherever the breast is and however the breast is; the implantation base of the breast and the location of the nipples can never be ignored, these are pillars to obtain a good result of the augmentation mammoplasty, as can be seen in this excellent case; if the patient is born with lateral breasts, the breast augmentation will not be able to modify this condition, since what the prostheses allow is to improve the breast, not its location, ignoring this principle always leads to a poor result.
No trace of deformity persists in the postoperative results, which show a well balanced breast, eradication of the conicity and tubular shape, no areolar herniation, full upper and lower poles, good cleavage and an absolutely normal natural breast mound; symmetry was quite substantially improved.
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