Tuberous breast: shape before volume

Correcting a congenital malformation such as the tuberous breast requires expertise, sensitivity, and great attention to the uniqueness of each patient. Professor Alessandro Innocenti, head of the Department of Plastic, Reconstructive and Aesthetic Surgery at the University of Florence, shares his insights. For years, he has studied and treated this condition both at the hospital and at his private clinic, Centro Medico Chirurgico Matteotti, also located in Florence.

According to Innocenti, tuberous breasts can present in many different clinical forms, which often makes diagnosis complex, especially in the less obvious cases. However, three recurring features help identify this malformation: an unusually high inframammary fold, areolar deformities, and increased distance between the breasts. Diagnosis remains primarily clinical and, as the professor emphasizes, relies heavily on the surgeon’s experience in recognizing even the mildest forms.
«A minor case that goes undiagnosed before surgery – he explains – can become a clearly visible issue after a breast augmentation, risking a compromised aesthetic outcome».

Tailored techniques for tuberous breasts

Innocenti believes the most effective surgical approach is based on glandular remodeling. These are techniques he has personally refined over the years, favoring the areolar approach to minimize scarring and achieve a more natural result. A particularly delicate aspect is correcting the inframammary fold, which is often improperly positioned in cases of tuberous breast.
«It’s essential – he stresses – to determine the new anchoring point of the fold during preoperative planning and to recreate consistent tissue thickness using adipose-glandular flaps. This helps avoid the so-called ‘double bubble’ effect that results from poorly executed corrections».

But in cases like these, plastic surgery isn’t just a technical matter. The human dimension is also deeply involved, especially in younger patients. Innocenti is clear:
«Adolescents often experience this condition with a strong sense of frustration, and in some cases, it’s the family that recognizes this distress and supports the surgical journey. This is one of the rare clinical scenarios in which the law permits the use of breast implants before the age of 18, starting at 16, in order to prevent physical and aesthetic discomfort from becoming an obstacle to social life and self-esteem development».
In these cases, the goal isn’t to increase breast volume, but to correct its shape, restoring proportion and balance to the silhouette.

When technology helps, but isn’t enough

In a time of rapidly advancing technology, plastic surgery is also embracing new possibilities. For example, 3D planning allows for the pre-visualization of surgical outcomes and clearer communication with the patient. Innocenti acknowledges the value of these innovations but warns not to overlook the human factor:
«Technology can help patients understand that not everything is possible. In the presence of a malformation, you can’t simply choose any shape or size you want. The surgeon’s role remains central: to listen, explain, and guide the patient toward realistic choices, focusing more on shape quality than volume quantity».

Sometimes, patients arrive with unrealistic expectations, influenced by unattainable aesthetic ideals or a distorted body image. In such cases, the professor calmly insists that awareness is key:
«An honest discussion, even in front of a mirror, helps identify real issues and choose the most suitable procedure. Awareness – he reiterates – softens initial whims and leads to a more harmonious, lasting result». In this context, the art of dialogue becomes an integral part of the surgical process.

Looking ahead: research and training

Looking to the future, Innocenti mentions two important upcoming events:
«Tuberous breasts have always been at the center of my clinical and scientific interest. For this reason, we’re organizing a dedicated meeting on the topic, scheduled between May and June next year. Earlier in the year, there will also be a congress on eyelid and periocular surgery, another field I follow with great attention».