Dr. Alejandro Nogueira's Case #WGKDCCQU

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, areolas with herniation and empty chest around the constricted base of the breast mounds.

The patient received areolar reduction, 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.

The breast droopiness remains intact, neither worse nor better than preoperatively, since no breast lift was wished by the patient; should she have wished a lift then a lollipop incision Lejour mastopexy would have been indicated and applied; anyhow this is an available option at any moment in the future.

In spite anatomical shaped implants are the preferred by the vast majority of patients due to their naturalness and higher efficiency filling up the upper pole of the breast, still some patients are eager to opt for the round shaped ones for seeking their ball shape effect at the cleavage, accepting their downsides in terms of hollow upper pole and a somehow fake effect, achieving satisfying results like this one.

Due to the particularities of the case and in order to prevent an upwards migration of the implants due to insufficient prostheses shell adhesion to the surrounding tissues, the patient opted for polyurethane coated implants which provide the highest grade of tissue adhesion from them all in the market thanks to their bio velcro effect, round shaped and cohesive gel filled, 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.

In spite of using ultra adherent implants, the patient suffered a mild upwards migration of her prostheses which was not deemed candidate for surgical correction given the highly rewarding postoperative result and minimal aesthetic downgrading due to this problem.