Tubular breasts: characteristics of the breasts and their treatment

Tubular breast deformity is a congenital malformation of the breast. It can occur on one side or on both breasts. Although the anatomical condition is present from birth, it usually only becomes noticeable when the breasts develop during puberty. The appearance may differ on each side.

In everyday language, this condition is also known as a ‘tubular breast’ or ‘trumpet breast’. These terms refer to the elongated or protruding shape of the breast. In the specialist literature, however, the terms ‘tubular breast’ and ‘tuberous breast’ are not used interchangeably throughout. One scientific study regards them as different manifestations of the same anatomical anomaly. ‘Tubular breast’ and ‘tuberous breast’ are therefore descriptive terms, but not uniformly defined diagnoses.

It is currently not possible to state with any certainty how many women have tubular breasts. The prevalence in the general population has not been reliably determined scientifically. Statements citing a fixed proportion of affected women should therefore be treated with caution.

The malformation affects the shape and size of the breasts, but does not cause the same changes in every patient. The term ‘deformity’ appears in medical publications. In this context, ‘breast malformation’ refers to the same anatomical change.

A characteristic feature is a narrowed breast base, i.e. the area where the breast rests against the chest wall. The areola may be enlarged. Occasionally, mammary gland tissue bulges forwards through the areola. As a result, the nipple may also appear more prominent, although the changes mainly affect the surrounding tissue.

• The base of one or both breasts is narrower than usual.
• The inframammary fold may be higher or displaced in some other way.
• Breast volume may be underdeveloped, with significant differences between the two sides.
• An enlarged or protruding areola may dominate the appearance.
• The breasts may be asymmetrical or sagging.

In mild cases, only the areola may be prominent, whilst the rest of the breast appears largely normal. Other patients have a more markedly reduced base, less volume or significant differences between the sides. Not every woman exhibits all of the characteristics mentioned.

To describe the condition, the specialist may assess each quadrant of the breast, i.e. one quarter of the breast area at a time. In doing so, they also document the lower quadrants and other parts of the breast. Such details help to understand the anatomical distribution of the underdevelopment. However, they are no substitute for a personal examination.

There are various classifications for the severity of the malformation. One clinical study used three levels, whilst other descriptions employ different systems. Terms such as ‘Grade 1’, ‘Type 2’ or ‘Type 4’ are therefore only understandable if the underlying classification system is also specified. A particular type cannot simply be transferred to a different classification system.

Breast malformation is considered to be congenital; however, its exact aetiology remains unclear. Scientific research into tissue structure and the underlying developmental processes is also limited. It would therefore be going too far to describe the condition as demonstrably genetically caused.

No confirmed preventable risk factors are known. Based on current knowledge, neither specific behaviour nor external influences can be identified as confirmed causes. The fact that the deformity only becomes apparent during puberty does not mean that it was caused by diet, exercise or personal hygiene. Rather, a change that was already present becomes visible during breast growth.

Targeted prevention is not possible based on the known causes. Nor can the exact course of the condition be reliably deduced from outward appearance before breast growth begins. Blaming the affected person or their family is not medically justified.

The diagnosis is based primarily on clinical assessment, that is, a medical examination of the breasts. During an examination, the malformation is identified after puberty has been completed on the basis of physical characteristics. Among other things, the breast base, inframammary fold, volume, asymmetry and areola are assessed.

The initial medical assessment focuses on the characteristics of the breasts. If surgical breast correction is required, a specialist in plastic and aesthetic surgery should be consulted. The professional association refers patients to a dedicated doctor search tool for plastic surgery specialists. Information on this speciality can be found under ‘Plastic and Aesthetic Surgery’.

Before any procedure, the surgeon should carefully examine both breasts. The existing volume of breast tissue, the position of the inframammary fold, the shape of the areola and any differences between the sides are all relevant to the planning process. Only by considering these individual characteristics can a suitable surgical procedure be selected.

Personal distress and expectations may differ from the anatomical characteristics. The personal significance of the breast and femininity varies from person to person. Any perceived psychological distress should be taken seriously, but it does not necessarily indicate a specific degree of severity nor the need for surgery.

Any new, increasing or otherwise noticeable change should be investigated by a doctor, regardless of whether a tubular breast shape is already known. This applies, for example, if a breast suddenly looks different from before. Depending on the findings, further examination of the breast may be necessary.

Surgical treatment is tailored to the initial anatomical condition and the desired corrective outcome. Various techniques have been described for tubular and other congenital breast malformations. There is no universally recognised optimal procedure. Correction of tubular breasts may therefore consist of a single procedure or a combination of procedures.

If there is sufficient volume, plastic reshaping of the glandular tissue may be sufficient. A published series of surgical cases described such a correction without additional augmentation. In another series, access was gained via an incision in the areola. The mammary glandular tissue was reshaped in the process.

Whether implants or autologous fat, pure tissue reshaping or a combination is appropriate cannot be determined solely on the basis of the visible severity of the condition. The specialist in plastic and aesthetic surgery takes into account both breasts, the distribution of tissue and the patient’s expectations.

Surgery is not compulsory. Surgical treatment options are available for women who wish to undergo correction. A visually noticeable breast shape alone does not determine whether a procedure is appropriate for an individual.

Before the operation, the anatomical features must be carefully assessed so that the appropriate procedure can be selected. This includes determining whether the patient’s own breast tissue is sufficient for reshaping or whether a breast augmentation is planned. Any differences between the two breasts should also be taken into account in the planning.

If an additional breast lift is being considered, any future plans to have children and breastfeed should be discussed in advance. The procedure may affect the ability to breastfeed. Before a planned breast lift, the professional association recommends reducing nicotine and alcohol intake to a minimum.

Following breast augmentation with implants, the professional association recommends wearing a supportive bra. This should be worn continuously for the first three weeks and then for a further three weeks, at least during the day. Aftercare may vary for other surgical procedures. The timeframes mentioned refer specifically to breast augmentation with implants.

When it is possible to resume everyday activities, sport and physical work depends on the extent of the plastic surgery. The factsheet does not specify a standard timeframe for this. During follow-up appointments, the treatment team assesses the healing process, the shape of both breasts and any potential complications.

Costs and potential cover must be clarified on an individual basis before breast surgery.

The course of recovery and the outcome depend on the patient’s original anatomy, the chosen technique and any complications that may arise. As there is no universally optimal surgical procedure, the prognosis cannot be determined solely on the basis of a classification grade. Even a carefully planned correction cannot guarantee a specific aesthetic result.

A systematic review of surgical treatment for tubular breasts reported a complication rate of 20 per cent. This figure summarises various studies, procedures and patients. It therefore does not allow for a prediction of individual risk.

In a retrospective comparative study, six serious complications occurred. All serious events were observed in the implant group. However, it does not follow that every operation involving implants is problematic or that autologous fat is inherently superior. The comparative study does not, however, replace the choice of procedure tailored to the patient’s anatomy.

Following breast augmentation with autologous fat, a systematic review described adipose tissue necrosis in 9.4 per cent of cases and calcifications in 1.2 per cent as imaging findings. These results relate to breast augmentation in general and do not apply specifically to tubular breasts.

The case series cited does not allow for any more far-reaching long-term conclusions. A case series on surgical correction reported an average follow-up of 25 months; the observed range was between 16 and 33 months. Such a case series can only provide a limited picture of subsequent changes or the outcome following other surgical techniques.

A tubular breast may affect physical and psychological well-being, but this is not necessarily the case. A study involving adolescents suggests possible impairments to physical and psychological quality of life. However, this does not necessarily imply the presence of a mental health condition.

The extent to which the shape of the breasts is perceived as distressing varies from person to person. Some affected women are bothered by the asymmetry or the visible areola. Others accept their breasts without significant psychological distress. A consultation can explain the medical options without dictating a decision based on aesthetic considerations.

Breastfeeding may be possible. However, if the mammary gland is underdeveloped, producing a sufficient quantity of milk may be difficult. The external shape of the breasts does not in itself indicate a breastfeeding problem. There is a link between the possible underdevelopment of the glandular tissue and the quantity of milk produced.

If you wish to breastfeed at a later date, the planned surgical procedure is also relevant. Particularly before a breast lift, it is important to discuss how the procedure might affect your ability to breastfeed. It is not possible to make a definitive prediction for any individual patient.