Understanding the anatomy of the tuberous breast is often helpful for patients as they are beginning to explore their reconstructive options. Breast development begins during the fifth week in utero . Further development continues until childbirth, and then remains dormant until puberty. At this time, the mammary tissue begins to grow beneath the areola, or pigmented region of the breast, continuing until completion at age or 15 or 16.
During development of the tuberous breast, breast tissue growth is constricted at the base of the breast. While the volume of breast tissue may be normal, it tends to be concentrated above the nipple. As a result, the breast may appear long and narrow, with herniation of the tissue through the areola. The areola therefore tends to be enlarged, and the base of the breast may be relatively narrow and tight. Tuberous breasts are generally classified into one of three categories, in which type I patients have a deficiency of tissue in the lower inner aspect of the breast, type II patients have less tissue in the lower inner and outer aspects, and type III patients lack tissue in all quadrants of the breast. While the extent of deformity varies from one patient to the next, all elements — the areola, the breast tissue, and the skin — must be addressed in order to produce an aesthetically appealing result. If an implant is simply placed without releasing the breast tissue, the result will be a breast mound which falls over the implant.
Patients with tuberous breasts almost always have significant asymmetry. In some cases, there are different grades of the deformity between breasts, while in others one breast may have developed normally. The opposite breast is generally reconstructed at the same time as the more affected breast if needed.