Due to the multitude of variants in which tuberous breast (TB) deformity could appear, a reconstructive algorithm could help to assess all features that affects the breast and, therefore, planning the most appropriate surgical strategy to correct the malformation. Although in the literature several efficient techniques have been successfully described, the authors propose their experience to standardize a diagnostic and therapeutic approach. The aim of this article is to assess the peculiar pathologic hallmarks of each type of deformity and to propose a one-step reconstructive algorithm tailored on the distinctive patients' characteristics, based on the use of three different adipo-glandular flaps.