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