The normal breast is born with certain ligaments which delimit its borders within the chest, which will be the theoretical area of surface to allow its development regardless its size; the most important of these ligaments are located at the inframammary crease, which is a very powerful one firmly joining together the breast skin, the lower end of the pectoralis muscle and the 7th or 6th ribs; this powerful structure anchors the breast to the ribcage and is the main anatomical landmark surgeons follow when planning any modality of breast surgery.
Second in importance is the ligament which forms the inner border o or cleavage; this one joins the skin, the inner border of the pectoralis muscle and the sternum or tie bone or eventually the rib arcs in some anatomical variations of chest configuration; this landmark is of great importance when the surgeons perform augmentation mammoplasties and insert breast implants.
As a general rule the upper pole and the outer quadrants of the breast are free of any ligament or physical frontier, thus in such areas the breast limit is in a smooth gradient or a slope formed by the growth of the breast tissue.
In short, the mammary mound is naturally born constrained or outlined by fibrotic or tendinous ligaments anchoring it firmly to the chest and pectoralis muscle at the cleavage and the inframammary crease; this provides the canonical breast shape of women's breast.
Tuberous or tubular breast suffer a congenital abnormality in these frontiers and ligaments; the upper pole and the outer quadrants are not free and this means they are oddly constrained by the same ligaments than the lower and inner areas of the breast, therefore the breast tissue cannot expand and occupy in a free manner those quadrants.
Additionally all four poles of tuberous or tubular breasts, inner, lower, outer and superior, are not only constrained without any free development option, those frontiers and ligament attachments do not form a square or trapezoidal surface to host the breast, as it is the available chest area for the mammary mound extension, but instead they form an authentic circle and only within this circular ligament will there be any kind of feasible breast tissue growth.
Moreover, that circular ligament frontier or attachment is located very far from the maximum limits of available surface for the breast on the ribcage, it is normally a very small area encircled by the ligament to host the tuberous or tubular breast; in other words, the frontiers of the breast are distant from the midline cleavage, the inframammary crease is abnormally high and near the areolar edge, the outer quadrants are far from the chest limits and the upper pole, instead of being free to form a natural slope, is absolutely empty and builds an abrupt step shape.
All the former leads to the typical and weird shape of the tuberous or tubular breasts which make them very unsightly and terribly dissatisfying for women; during their growth the constriction ring deforms the mammary mound and turns it into a kind of tubular structure with over expanded areola, total absence of the lower pole, null inner and upper cleavage and lack of fullness towards flank and armpit.
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