What are the causes of tuberous breasts?

Breast deformities can cause significant psychological distress and self-esteem problems, particularly in young women. Tuberous, tubular, or hypoplastic breast deformities are characterised by conic or cylindrical shape. The condition is relatively rare and is not a health risk. However, some may want to consider surgical correction for aesthetic reasons.

The condition has been well-documented, and there are three, potentially, four types of tubular breasts. Little is understood about the cause. Here, we discuss the characteristics of tubular breasts. Then we review the possible causes of the condition and how it manifests. Finally, we address the risk factors of tubular breast syndrome and the possible treatment options.

What characterises tubular breasts?

Tuberous breasts have so far been diagnosed symptomatically. Typically, hypoplastic breasts display restricted vertical and horizontal breast development, leaving an elongated, conic, cylindrical or oval shape. However, a universal characteristic of tubular breasts is the weakness of the nipple-areolar complex. A herniation is a common trait. In fact, isolated herniation of the nipple/areola (with a typical breast base) has been proposed to be included in the diagnosis of tubular breasts. Below is a summary of the symptoms of tubular breasts:

• Enlarged, protruding nipple/areola

• Conic, cylindrical or oval shape

• Limited breast development horizontally and vertically

• Breast hypoplasia in the lower quadrant

• Drooping breasts

• Asymmetric breasts

• Overall lack of breast tissue

• Small breast base

• Downward, upward or outward-pointing nipples

• A large gap between breasts (Wide-set, over 1.5 inches).

What are the possible causes of tubular breasts?

A combination of two factors is thought to cause tubular breasts – the weakness of the connective tissue around the nipple-areola complex and the thickening and constricting of the breast fascia. The breast fascia encases the breast tissue and plays a role in determining breast shape. A tightened breast fascia can ‘tunnel’ breast tissue forward, causing it to herniate the NAC, forming a bulging areola.

Research found that patients with tubular breast deformities had significantly higher collagen deposits in the connective tissue surrounding the breast parenchyma. The consequence is a non-elastic, fibrous ‘ring’ of tissue that restricts the normal development of the breasts, leading to their conic shape and underdevelopment, particularly in the lower portion of the breast.

There is no known cause of these excessive collagen deposits. However, they may be linked to the prenatal environment or genetics. A researcher observed that a pair of identical twins had tubular breasts suggesting a potential genetic or developmental cause.

Find out more about treatments for tuberous breasts here.

What are the risks of tubular breasts?

Fortunately, hypoplastic breast deformities are entirely harmless. Most do not experience any discomfort and can breastfeed normally. In some cases, breastfeeding can be impaired due to insufficient breast tissue.

The most significant risk with tubular breasts is their tendency to impact the patient’s mental health. Many struggle with self-esteem issues relating to breast size and shape, nipple prolapse and potential breast asymmetry (which is very common).

“I like helping these young patients. Their confidence and well-being are normally very affected by how their breasts look…Surgery is truly life-changing for a lot of them.”

– Elena Prousskaia, 2023.

Treatment options for tuberous breasts

The condition develops in puberty, and there is no way to prevent the formation of tubular breasts. Since the deformity can have significant psychological impacts, many turn to plastic surgery to correct the breast shape.

Traditional augmentation surgery usually can’t address the fibrous constriction of the breasts and can leave the patient with poor aesthetic outcomes. A different approach needs to be taken for tuberous breasts.

You can find out more about tuberous breasts surgery here.

Dr Elena reveals that “Correction of tuberous breast(s) requires not only the use of implants but also breast tissue remodelling.” First, the surgeon must disturb as much fibrous tissue as possible to release the constricted breast tissue. A breast implant can fill the missing volume, while breast tissue removal can help minimise the deformity, particularly for gynaecomastia. “In cases of severe deformity, two-stage procedures can be done. Firstly, a balloon called “an expander” is inserted and inflated gradually to stretch the skin to the desired size…[then] the expander will be exchanged for an implant”, explains Dr Elena. Your plastic surgeon may use a combination of techniques for the best results.

Typically, the surgeon will reduce the areola size by making a doughnut-shaped incision to remove some excess skin. The patient may have scars on the underside or around the areola (round-block) or a vertical scar underneath the breast.

Sources

• The tuberous breast deformity: classification and treatment

• Tuberous Breast: Revised Classification and a New Hypothesis for its Development

• Aesthetic Reconstruction of the Tuberous Breast Deformity

• Tuberous Breast Surgery

• Tuberous breast: Morphological study and overview of a borderline entity

• Unsolved Mysteries of the Human Mammary Gland: Defining and Redefining the Critical Questions from the Lactation Consultant’s Perspective

• Central Mound Mastopexy for the Correction of Tuberous/Tubular Breast Deformity

• Tuberous Breast: A New Approach

• Tuberous Breast Deformity Correction Surgery: Live Streaming Plastic Surgery by Dr Michael J. Brown

• Tuberous Breasts: A Periareolar Approach

• Tuberous Breast Deformity