Tubular breasts, also known as tuberous breast deformity (TBD), is a congenital condition that affects the normal development of the breasts during puberty. While often mistaken for simply small breasts, TBD is primarily an anomaly of breast shape and structure. The condition becomes noticeable during adolescence as the breast tissue begins to grow but is restricted by a fibrous ring, resulting in an abnormal, often conical or tube-like appearance. This developmental difference can vary in severity and may affect one or both breasts, often leading to a noticeable asymmetry.
Defining the Physical Characteristics
The defining feature of a tubular breast is the constricted base, meaning the breast tissue fails to expand outward across the chest wall. Instead of developing a broad, rounded footprint, the breast often appears narrow and elongated. This structural limitation is compounded by a deficiency of breast tissue, particularly in the lower pole, which is the area beneath the nipple down to the inframammary fold.
The inframammary fold is frequently positioned higher than normal, which further contributes to the breast’s short, saggy appearance. Another common characteristic is the herniation or protrusion of the glandular tissue through the areola, often causing the areola to appear enlarged, puffy, or dome-like. Because of the volume deficiency and the narrow base, the breasts may also be set wider apart than typical, increasing the space between them.
Understanding the Underlying Causes
Tuberous breast deformity is considered a congenital anomaly, meaning the predisposition is present from birth, although the physical signs only become apparent during puberty. The most widely accepted theory attributes the condition to an abnormality in the connective tissue structure beneath the breast. This defect forms a tight, inelastic fibrous ring around the base of the developing breast mound.
During the normal hormonal surge of puberty, the breast tissue attempts to expand. However, this constricting fibrous ring prevents the glandular tissue from spreading outward across the chest wall. The restricted tissue is therefore forced to grow forward and through the path of least resistance, which is typically the area of the areola. This abnormal growth pattern explains both the narrow, tube-like shape and the characteristic areolar protrusion.
Classification and Severity
Plastic surgeons use specific grading systems, such as the Grolleau classification, to classify the severity of TBD and guide the surgical approach. This system categorizes the deformity based on the deficiency in the breast’s quadrants.
Type I
Type I is the mildest form, involving a tissue deficiency primarily in the lower medial quadrant of the breast. This minimal involvement may only present as a slight narrowing of the base.
Type II
Type II is characterized by a deficiency in both lower quadrants—the lower medial and lower lateral areas. This results in a more noticeable constriction and a higher-than-normal inframammary fold.
Type III
The most severe presentation, Type III, involves a deficiency across all four quadrants of the breast, leading to a greatly restricted mammary footprint and global hypoplasia. A modern revision also includes Type 0, which describes isolated areolar protrusion with an otherwise normal breast base.
Surgical Correction Options
Correction of tubular breasts requires surgery to address the underlying structural defect. The primary goal of the procedure is to release the constricting ring, redistribute the existing glandular tissue, and restore the breast to a normal, rounded shape. The surgeon typically begins with a periareolar incision, minimizing visible scarring.
The procedure involves releasing the tight fibrous ring at the breast base through a technique called radial scoring. This involves making small, spokelike incisions into the glandular tissue, perpendicular to the chest wall, to allow the tissue to spread and the base to expand. To correct the deficiency in the lower pole, surgeons often employ tissue rearrangement techniques, such as fashioning a glandular flap from the subareolar tissue and folding it down to fill the lower quadrant.
Breast implants are frequently used in combination with these reshaping techniques to provide necessary volume and projection. The implant helps to maintain the expanded breast base and push the tissue into a more aesthetic shape. Finally, the enlarged or herniated areola is addressed by removing a ring of excess tissue, effectively reducing its diameter and creating a proportional appearance.