Bilateral Tuberous Breast Deformity: Diagnostic Dilemma and Single-Stage Surgical Correction with Intra-areolar Approach

Abstract Tuberous breast deformity is one of the rare congenital breast anomalies that pose a diagnostic dilemma and hence delay in treatment. It usually presents as a breast base constriction with or without breast hypoplasia. We present an intra-areolar technique for correction of breast base constriction along with hypoplasia correction in a single stage, leading to improvement of breast contour aesthetics and deformity correction. This is a retrospective review of 15 patients with Type IV (von Heimburg, 2000) tuberous breast deformity operated on from August 2020 to August 2025. All patients filled out the BREAST-Q questionnaire (Augmentation module) before and after surgery. All BREAST-Q scores range from 0 to 100. The scores are computed (from the responses) and converted to a scale from 0 to 100 (similar to conversion into a percentage). A higher score means high satisfaction or better health-related quality of life. The technique is based on an intra-areolar approach, which gives easy access to the breast base constriction, which is released circumferentially with almost invisible scar posthealing. Areola is usually expanded in this deformity, and an intra-areolar approach is most feasible for simultaneous breast base constriction release up to the pectoralis fascia all around and placement of implant to correct hypoplasia in same session. All procedures were done by the author himself. Breast aesthetics and contours are achieved with volume augmentation required by a single-stage surgical procedure in cases of tuberous breast with hypoplasia with almost invisible scar. Patients are highly satisfied as this technique not only improves breast contour but also boosts their confidence overall with almost imperceptible scar. The BREAST-Q Likert-scale responses demonstrated marked improvement in all assessed domains with significant enhancement in patient-reported psychosocial, sexual, and physical well-being, along with increased satisfaction regarding breast appearance and surgical outcomes. This deformity remains a diagnostic dilemma as it is perceived as congenital breast underdevelopment/hypoplasia by patients and physicians in general, hence the delay in seeking early treatments. In this article, we shall discuss the described techniques and detail our intra-areolar technique for improving breast aesthetics. Level of evidence is 5.