Tuberous breast deformity (TBD) is a congenital condition characterized by the unusual development of the breast, becoming apparent as the breasts grow during puberty. This anatomical variation, not a disease, occurs when breast tissue fails to expand normally across the chest wall. The condition is a structural issue that affects the shape, size, and position of the breasts, often leading to noticeable asymmetry. The name refers to the distinctive constricted or tubular shape the breast often assumes, which can range significantly in severity.
Defining the Appearance
Tuberous breast deformity presents with distinct physical characteristics. The most defining feature is a constricted breast base, where the area attaching to the chest wall is unusually narrow. This constriction prevents the breast tissue from spreading horizontally or downward, resulting in a narrow, elongated, or tubular shape that projects forward instead of having a natural, rounded contour.
Another common sign is the herniation of glandular tissue, where internal breast tissue pushes through the nipple-areola complex. This causes the areola to appear enlarged, stretched, or “puffy.” The skin envelope holding the breast tissue is often tight and insufficient, especially in the lower quadrants.
The inframammary fold, the crease beneath the breast, is frequently positioned higher than normal due to tissue restriction. This combination of a narrow base, tissue deficiency in the lower pole, and an elevated fold contributes to the unique appearance. Although the condition often affects both breasts, a high degree of asymmetry is common, with one breast displaying a more pronounced deformity.
How Tuberous Breast Develops
The root cause of tuberous breast deformity is an abnormality of the connective tissue structure that forms during fetal development. This congenital issue becomes apparent when the breasts undergo rapid growth during adolescence. The primary mechanism involves a dense, non-compliant ring of fascia, a type of connective tissue, located at the base of the developing breast. This restrictive fascial ring acts like a tight band around the breast mound.
As hormonal changes trigger breast tissue growth, this tight band prevents the glandular tissue from expanding laterally and inferiorly. The tissue is forced to grow forward, resulting in the characteristic tubular shape. The failure of the lower breast quadrants to develop fully is a direct consequence of this restrictive ring limiting normal outward expansion.
Options for Correction
Correction for tuberous breast deformity is primarily surgical, as the issue is structural. The goals of the procedure are to release the restrictive constriction, redistribute existing glandular tissue, and achieve a more natural shape and symmetry. The surgeon must first release the tight fascial ring at the breast base to allow for proper expansion. This is often accomplished through internal cuts, such as radial scoring, performed on the glandular tissue.
Once the base is released, the breast tissue is reshaped using glandular plasty to fill out the lower pole of the breast. To address the enlarged or herniated areola, a periareolar mastopexy is often performed to reduce the areola size and reposition the nipple-areola complex.
Depending on the severity of the constriction and desired volume, a breast implant may be required to provide sufficient fullness, particularly in the lower quadrants. Implants are typically placed partially beneath the chest muscle to help expand the tight skin envelope. In severe cases, a two-stage approach may be necessary, beginning with a tissue expander to gradually stretch the skin. Fat grafting can also be utilized to smooth contours and fill minor deficiencies.