Mandrekas expanded on this with a ring theory by histologically demonstrating a dense constricting ring spanning from the periphery of the NAC to the lower part of the breast representing a thickening of the superficial fascia. 00 He postulated that this condensation of fascia may be caused by the joining of the deep and outer layers of the superficial fascia, which collectively envelope the breast, at a higher level, or a thickening of penetrating suspensory ligaments in the area. The constricting ring prevents normal breast expansion and development, and the breast tissue is forced through the outer layer of the superficial fascia resulting in vertical breast development herniating through the areola.
The true incidence of tuberous breast deformity is variable and somewhat unknown. DeLuca-Pytell et al. reported 00% of females presenting for breast augmentation were found to have tuberous breast deformity, with the 00% of breasts having the most severe phenotype (Type III). 0 Ninety-eight percent of the patients with tuberous breasts were asymmetrical in size as well. However, such high incidence is debated, particularly by Zambacos and Mandrekas who report a 0% incidence among those who present for mammoplasty. 00 This discrepancy represents a diagnostic dilemma in tuberous deformity, as milder forms are commonly underappreciated and underdiagnosed. 0