Breast Augmentation/Tuberous Breasts
Early during the consultation she mentioned she was here to see about breast augmentation, which isn't completely unheard of for a 17 year old, but again, usually in a breast augmentation consultation for a teenager, there's more than one teenager in the room, and usually a parent as well. This solitary young woman listened intently as we discussed the procedure in general terms. After the first part of the consultation, I left the exam room so the patient could change out of street clothes into a robe for a physical exam.
As I returned to the room for the exam and initially saw her breasts, I began to understand a bit more about her situation. She explained she didn't want to be "big", but asked if there wasn't there something we could do? I asked her if she knew the term "tuberous breasts", but she didn't. This wasn't just a teenager with body image issues; she had tuberous breasts. I explained to her that she had a medical condition in which during the early growth of the breast, the tissue is restricted leading to unusually small, drooping and uneven breasts. In most cases, tissues inside the breast push against the areola causing it to bulge and enlarge. If not diagnosed properly and a surgeon tries to correct the problem by placing an implant in the tubular breast, the breast sags even more dramatically leaving the patient completely devastated. While an implant is used to correct the size and shape of tuberous breasts, it is not a traditional breast augmentation procedure. The procedure done is part augmentation, part mastopexy (breast lift) and part reduction which when done by an experienced, board certified plastic surgeon, results in a much more normal looking breast.
The tuberous breast condition is a congenital abnormality that presents with breasts that have very little breast tissue, and whatever tissue there is, is unusually dense. Because of the abnormal breast tissue, breast-feeding is often compromised. The areola is large and puffy looking, and the chest wall is very narrow but there's a wide gap between the breasts. There's no known specific cause for this condition that affects about 1% of the population, including a few males. The unusual shape the breasts take can result in unflattering terms like "torpedo t*ts" or "Snoopy breasts" which can be especially damaging as the condition appears in adolescence.
While explaining the tuberous breast condition to this young woman, her entire demeanor changed. She was clearly relieved to find out that there actually was something wrong. I asked her if she had told her parents about coming to see me, and she had not. She had done all the research and consultation scheduling on her own. I explained that her condition was absolutely treatable, but to do so she would need her parents' consent. The next day she and her Mother came in to see me. Mom cried. Daughter cried. Although the daughter had told her Mother that she thought there was something wrong with her breasts, her Mom understandably perhaps, thought she would out grow it. Knowing the struggles, insecurities and embarrassment her daughter had suffered without her support was now breaking the mother's heart, and she was just beginning the process of dealing with some guilt because she didn't listen to her daughter. "I just didn't know. I never saw her breasts, and I assumed she was just being impatient because her friends all developed before she did."
We doctors are privy to some pretty personal stuff in our patients' lives. Working through this medical issue, first with the daughter and then with the mother gave my entire staff a peek into their family. While the mother felt like she had failed the daughter, she did the best thing she could do at that point. That night when they returned home after the second consultation, they sat down and shared the story with "Dad". Three weeks later when the patient came in for surgery, much of her extended family came with her for support. By this time the tears had dried. The family had done a great deal of research on tuberous breasts and had some insightful questions for me when I came to give them the report after surgery. The mood was definitely one of support and love.
The patient made a quick, routine recovery and is a much more confident and comfortable 20-something college graduate now. Her courage and strength touched all of us, as did her family's resilience and tenacity. Tuberous breasts had impacted this young woman's life, but she had the courage to not let it negatively impact her future.