Remarkable Case of Tubular Breast Correction with Coleman Fat Grafting

Tuberous Breasts
Treated with
Coleman Fat Grafting

In past blogs we have discussed the nature of tuberous breasts and how they can be corrected using the Coleman fat grafting technique. (see our recent blog, “Sydney Coleman Explains the Tuberous Breast Deformity” available on the blog archive on our website, lipostructure.com). We have shown before and after photos documenting the long-term amazing changes that can be achieved in tubular breast correction through fat grafting. Here, we will discuss the details of the procedure for one of our patients.

The patient above was an otherwise healthy 21 year old woman with severe bilateral tuberous breast deformity. As you can see, her breasts were very small and constricted, and the nipple/areola complex was quite protuberant and pointed downward. This patient was very bothered by what she considered an ugly, embarrassing deformity, not wanting even her mother to see her undressed. She researched the condition on her own, and found a discussion of tuberous breasts on our website, lipostructure.com. She underwent two surgeries performed by Dr. Sydney Coleman to achieve her final result. In order to enlarge the skin “envelope” into which we could place fat, we had the patient wear the BRAVA expansion device for 3 weeks prior to surgery. (You can read a more detailed discussion of how the BRAVA device works in our blog archive, under “Combining the BRAVA System with Fat Grafting to the Breast.”) At the first surgery, we placed a total of 267.5cc of structural fat into the right breast, and 328.0cc into the left breast. We harvested fat from her abdomen, flanks, hips and thighs. Fat was placed into all areas of the breasts (with the exception of the area behind the nipple/areolar complex) as well as up into the underarm areas and cleavage to create a more natural shape. Tiny incisions for fat placement are hidden in the folds under the breasts and in the border of the areola (where the darker edge blends in to the surrounding lighter skin.) The patient wore the BRAVA device for about 3 weeks after the procedure to increase the survival of the transplanted fat by stimulating the development of a new blood supply in the grafts. Her breasts were much more normal in appearance, and the areolas no longer protruded. However, the lower portion of the breasts still appeared constricted and less full than normally shaped breasts. This patient desired further improvement, and elected to have a second procedure 15 months after the original surgery. She did not wear the BRAVA before or after the second procedure, as we felt there was adequate tissue expansion and room for additional fat. At the time of the second surgery, we again harvested fat from the abdomen and lovehandle/flank areas. We placed 335.0cc of structural fat into the right breast, and 317.5cc into the left breast. There was no need for additional placement of fat into the axilla or cleavage during this surgery. 7 months after her second session of Coleman fat grafting

7 months after her second session of Coleman fat grafting

7 months after her second session of Coleman fat grafting. Note the change in shape of the lower, constricted breast.

The patient did extremely well, as you can see from photos above 7 months after her second surgery. After tubular breast fat transfer she now feels that her breasts are totally normal and natural, and no longer feels disfigured. She is no longer held back by negative feelings about her body, and feels free to lead a normal life.

–Written by the Staff at TriBeCa Plastic Surgery

Blog posts on tuberous breasts.

What is a Tuberous Breast?

How Can We Correct a Tuberous Breast?

Twelve year follow-up of tuberous breast correction

Coming soon: more clinical pictures of patients in whom tuberous breast correction has been performed with fat grafting

FOR MORE INFORMATION ON BREAST FAT GRAFTING, PLEASE GO TO THE LIPOSTRUCTURE WEBSITE.

Check out these links for more information on fat grafting to the breasts:

Coleman Shows Longevity of Fat Grafting to the Breasts

New York Times Reports on Fat Grafting to the Breast

Combining the BRAVA system with Fat Grafting to the Breast

Fat Grafting to solve problems with Breast Implants

Safety concerns with fat grafting to the breast

The American Society of Plastic Surgery’s Position of Fat Grafting to the Breast

Dr. Sydney Coleman demonstrates Breast Reconstruction with LipoStructure on The Doctors

Coleman lectures on fat grafting for breast reconstruction at the American College of Surgeons

Breast Augmentation Via Fat Grafting From “Plastic Surgery Practice”

Breast Implant Problems Solved with Coleman Fat Grafting

Fat Grafting to the Breast Revisited: Safety and Efficacy. Plastic & Reconstructive Surgery. 119(3):775-785, March 2007. Coleman, Sydney R. M.D.; Saboeiro, Alesia P. M.D.

Tuberous Breast Correction Using Coleman Fat Grafting

How Can We Correct a Tuberous Breast?

Correction of a tuberous breast is a difficult problem that can best be solved in a natural manner with Coleman fat grafting instead of silicone breast implants or more invasive surgery. The transplanted fat is layered under the skin with an emphasis on placing a greater volume in the lower pole (lower third of the breast). This stretches out the tight band of skin associated with tuberous breasts so that a more natural downward sloping curve is created.

The key to tuberous breast correction with transplanted fat is to change the relative proportion of the nipple/areolar area to the rest of the breast, so that there is more fullness in the surrounding areas and less fullness behind the nipple and areola. In the diagram below a tuberous breast is represented on the left, and tuberous breast corrected with fat grafts on the right. Note that the yellow pearls of transplanted fat are located under the skin up to the areola. However, no fat is located in the breast tissue or under the areola or nipple.

Side view of tuberous breasts demonstrating correction with placement of fat grafts deep to the skin but not under the areola

Front view of left breast showing placement up to areola but not under the nipple or areola in order to change the relative proportion of the breast.

No fatty tissue is placed deep to the areola or nipple, only under the surrounding skin envelope. The structural fullness from the fat placed under the skin causes expansion of the outer portion of the breast and “overwhelms” the large nipple -areolar complex. The nipple-areolar complex effectively “shrinks” as the surrounding skin enlarges. This change in relative proportion creates a more natural-appearing and shapely breast, especially with expansion of the lower pole.

Sometimes more than one procedure is required to achieve the desired effect. We often suggest the use of the BRAVA device before and after surgery to maximize the breast “envelope” or space into which fat can be grafted.

Insurance may cover part of the costs of the procedure.

–Written by the Staff at TriBeCa Plastic Surgery