Types of tuberous breasts and how to recognise them: the Grolleau classification

What are tuberous breasts?

Tuberous breasts are a congenital malformation of the breast gland that shows itself as abnormal development of the breast during puberty. Instead of expanding evenly, the breast tissue meets a fibrous resistance that prevents it developing fully, particularly in the lower pole of the breast. That produces a tubular or elongated breast shape, a narrow breast base and, frequently, a widened areola that may protrude outwards.

This disorder affects not only the appearance of the breast: in some cases it can cause significant asymmetry between the two breasts, herniation of the areola, and emotional difficulties bound up with body image.

Causes and factors involved

The exact causes of tuberous breast development are still not fully defined. Several studies do, however, point to a possible genetic predisposition, involving changes in the composition of collagen and in the distribution of fibrous tissue. Those changes stop the breast gland growing properly, creating tension in the tissue that produces the characteristic tubular shape.

How to recognise tuberous breasts

This condition has to be diagnosed by a plastic surgeon experienced in breast disorders. Even so, there are several signs that may indicate the presence of tuberous breasts:

• A lower pole of the breast that is poorly developed or flat.
• A narrow breast base, particularly across its width.
• Large, widened areolae, often protruding.
• An elongated, narrow breast shape, rather like a tube.
• Visible breast asymmetry, in both size and shape.
• An inframammary fold that is high or poorly defined.

In many cases these signs appear from adolescence onwards and remain stable over time.

Classification of the types of tuberous breast

One of the most widely accepted systems for classifying this malformation is the one proposed by Grolleau, which divides tuberous breasts into three types according to the severity of the defect:

• Type I: the defect lies in the lower inner quadrant of the breast. There is usually volume in the rest of the gland, but the lower inner pole shows marked retraction.
• Type II: the lack of volume affects both lower quadrants, and comes with an areola displaced downwards and a short lower pole.
• Type III: all the quadrants of the breast are affected. The breast has a very narrow base both horizontally and vertically, and the deformity is severe.

Correctly identifying the type makes it possible to plan a more precise and individual operation.

Where this classification comes from (and what its numbers teach)

The three-type classification is not a consulting-room convention: it comes from a paper by Grolleau and his team published in 1999 that sorted these breasts by one very specific criterion, which quadrants of the breast base are deficient:

• Type I: only the lower inner quadrant is missing.
• Type II: both lower quadrants are missing.
• Type III: the base is deficient in all four quadrants.

The most useful thing about that paper, covering 37 patients, is the proportions, because they dismantle the picture people usually have of this malformation: mild forms were the most frequent — 54% of the breasts treated —, 81% of patients had combinations that included at least one minor deformity and 70% had an asymmetry of more than 100 grams. Volume also varied a great deal: 27% of breasts were underdeveloped, 45% normal and 28% overdeveloped.

Put another way: the typical tuberous breast is not the most striking one but the mild, asymmetrical one, and that is why it goes unnoticed for years. A later review by the same group acknowledges it plainly: its true incidence is unknown precisely because milder forms are harder to diagnose.

From that follows what really determines the treatment. Types II and III need the gland reorganised with parenchymal flaps and are not resolved simply by placing an implant; in the words of that same review, it would be illusory to think that every type can be corrected with the same technique in a single stage. And the authors of the original paper already warned that secondary revisions are frequent in every grade: that is worth knowing before surgery, not after.

How are tuberous breasts corrected?

Corrective surgery is the most effective treatment for tuberous breasts. The aim is to reconstruct a natural, symmetrical breast shape, adapted to the patient’s anatomy and expectations. At the Instituto de Cirugía Plástica del Mediterráneo we work with an individual approach, assessing each case carefully.

The most usual surgical procedures include:

• Periareolar incision: used to reduce the size of the areola and to correct the herniation of tissue into it. This route of access also allows the glandular tissue to be reshaped from within.
• Redistribution of the gland: through strategic cuts, the breast tissue is released so that it can expand and occupy the space that was previously restricted. This makes it possible to reshape the natural volume of the breast or to prepare the area for an implant.
• Extending the lower pole: the lower part of the breast, usually underdeveloped, is reconstructed. Sometimes the inframammary fold is redefined.
• Placing implants: in many cases breast implants are needed to give volume and shape. The choice of implant (shape, projection, volume and cohesiveness) is made individually.
• Fat transfer: in some cases the patient’s own fat is used to improve the shape of the breast, either on its own or combined with implants.
• Complementary techniques: where there is excess skin or droop of the breast, a breast lift or an inverted-T scar may be needed.

Every operation is designed to achieve a result that is proportionate, natural and stable over time.

How long does recovery take?

Recovery depends on the complexity of the case and the technique used. In general, the patient can return to her usual routine in about 7 to 10 days, although she will need to avoid intense physical activity for at least 4 to 6 weeks.

Swelling and tenderness may appear in the treated area during the first few days. Wearing a post-surgical bra is essential in maintaining the result and avoiding complications. It is also advisable to avoid sleeping face down and to follow the medical team’s instructions on hygiene, pain control and care of the scars.

What results can be expected?

When carried out by a surgeon experienced in reconstructive breast surgery, correction of tuberous breasts gives very satisfactory results. The breasts take on a rounder, more harmonious and more symmetrical shape, and the areola regains a size and a position that are more in proportion.

At our clinic in Valencia, close post-operative follow-up is carried out to make sure recovery progresses as well as possible.

At what age can surgery be done?

The best course is to wait until breast development is entirely complete, which usually happens between the ages of 17 and 18. Where the emotional impact is severe, however, surgery at an earlier age may be considered, provided there is sufficient physical and psychological maturity.

Does it affect breastfeeding?

One of the most frequent questions is whether a woman who has had surgery for tuberous breasts will be able to breastfeed in the future. The answer depends on the type of operation carried out and on how far the milk ducts are affected. At our clinic, wherever possible, we apply conservative techniques that respect the internal structures in order to preserve the ability to breastfeed.

Why does it matter to choose a specialist clinic?

Correcting tuberous breasts is not conventional aesthetic surgery. It is an operation that calls for advanced knowledge of breast anatomy, surgical experience and the ability to plan a strategy fitted to each type of malformation.

At the Instituto de Cirugía Plástica del Mediterráneo in Valencia we have surgeons who specialise in this kind of breast anomaly, as well as advanced medical technology, digital surgical planning tools and a wide range of high-quality implants.

Our approach rests on:

• Precise diagnosis through clinical examination and digital tools.
• Individual advice with both an aesthetic and a reconstructive eye.
• A surgical plan adapted to the patient’s anatomy and goals.
• Complete postoperative follow-up.

Tuberous breasts can be corrected with excellent results, both aesthetic and emotional. The right operation improves the shape of the breast, balances the figure and restores the self-esteem of those who live with this condition. If you think you may have tuberous breasts, or you want to discuss your treatment options, we invite you to request an appointment at our clinic in Valencia. We will be glad to help you regain confidence in your body, with the safety and the backing of an expert medical team.

Sources

• Grolleau JL, Lanfrey E, Lavigne B, Chavoin JP, Costagliola M. Breast base anomalies: treatment strategy for tuberous breasts, minor deformities, and asymmetry. Plast Reconstr Surg. 1999;104(7):2040-2048. PMID 11149766 — the paper that defines the three types according to the deficient quadrants of the breast base; 37 patients, with a predominance of mild forms and of asymmetry.
• Ellart J, Chaput B, Grolleau JL. Sein tubéreux: concept actuel [Tuberous breast: Current concept]. Ann Chir Plast Esthet. 2016;61(5):640-651. PMID 27646657 — a review by the same group: the true incidence is unknown because milder forms are hard to diagnose, and types II and III require the gland to be reorganised, not just an implant.