Ask a doctor

Breast Lift or Just Nipple Reduction?

I've been to several consults with plastic surgeons. One refused to work on me at all, one offered to do a nipple reduction only, one offered to do a nipple reduction with an implant to make them fuller, and one offered to do a complete breast lift with implant. I am very confused about the route I should take. Please help!

Doctor Answers (19)

Breast lift or nipple reduction depends on the kind of result you seek

+4

You present the hardest issue in plastic surgery. First of all you have a nice breast and I would suggest that you leave them alone for now.

You do not have sever sagging of the breast tissue. You have fair amount of breast tissue. There is fair amount of difference between your breast.

If you get only implants this will cause more stretching and enlarging of the nipple aerola complex. You will also sag soon after surgery.

If you get implant and lift (nipple lift or compelete breast lift), There is high risk of implant malposition, nipple loss, and stretched incision. Fifty percent of the plastic surgeons will not do lift and implants at the same time.

Please think hard before going through with surgery. When you get many different answers from well qualified plastic surgeon, this means that there is no good answer.


New Orleans Plastic Surgeon
5.0 out of 5 stars 51 reviews

Breast options

+3

Your photo is grainy but does seem to show that your breasts are asymmetrical with your right one lower than the left and both with enlarged areolas (not nipples). I would suggest a small implant to add some upper pole volume with periareolar lifts to improve the symmetry of the areolas and decrease their diameter a little. Many photos of this are on my web site.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 47 reviews

Breast surgery?

+2

Thank you for the question and picture.  

 

The “route”  you take surgically (if any) depends on what your goals are.   In other words, what are you trying to achieve?  Once you are able to clearly identify your goals it will become obvious what surgical procedure will help you reach your goals. Otherwise, every surgeon you see will have an opinion:  most of them irrelevant.

Some general words of advice may be helpful:

 

Much of the final “look” achieved after breast augmentation surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.


2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.


4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.



I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 681 reviews

You might also like...

Breast lift or not?

+2

The question is what do you want? What are your expectations? What don't you like about your breasts. forget what you have been told. Are you happy with your size. Does your minor asymmetry bother you or is it just your areolar size. Once you have answered these questions, you can make a n informed decision from a periareolar reduction and mild lift  with not implants up to implants with a lift.  Don't sell yourself short.

Richard Linderman, MD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 7 reviews

Know what you want

+2

the question is what is your complaint ?

is it the size of your breast ,nipples or the position of them .

from the picture i didn't see obvious deformity .u  have to know what bothers you so doctors can help you

Nawarah Alarfaj, MD
Saudi Arabia Plastic Surgeon

Breast lift in Manhattan

+2

Hi.

1)  The most important question is what don't you like about your breasts.  Surgical plan based on that.

2)  Just from your picture, I would say a breast lift just with scars around your nipples (Benelli) will both make your nipples smaller (really your areolas), and correct the mild sagging.  I don't think you need breast implants.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

The process of deciding the proper surgery for you

+2

You are not having surgery to please your plastic surgeon. You are having surgery to achieve a certain goal. It is a plastic surgeons job to tell you if and how that can be achieved as well as the risks and alternatives.

Figure out your goals:

  1. smaller/larger breasts
  2. smaller/larger areola and/or nipples
  3. fuller breasts
  4. lifted breasts
  5. less uneven breasts

Also determine your level of risk tolerance as well as acceptance of scars.

I think this will help tremendously in the decision making process.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 41 reviews

Breast surgery

+2

The photo is a bit blurry and certainly an exam in person would be more appropriate. I assume that you do not mean nipple reduction but rather an areola reduction. This can be performed in a fairly straightforward way.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Breast lift or just areolar reduction

+2

It really depends on what really bothers YOU.
The options you were offered:
- areolar (round darker skin around the nipple) reduction only,
- breast lift
- areolar reduction with an implant or
- breast lift with implant

are each meant to address a specific complaint.

If all you want is for the areolas to be symmetrical in size - you need an areolar reduction

If all you want is to lift your breasts and keep them the same size - a Breast Lift (Mastopexy) is called for

if you want your areolas made more symmetrical and would like larger, fuller breasts - an areolar reduction / periareolar placement of breast implants would do it.

Finally, if you wanted more symmetrical and fuller breasts, you would need bilateral Augmentation Mastopexies (lifts).

It call comes to YOUR specific needs.

Good Luck.

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 58 reviews

Get evaluated by a plastic surgeon for Breast lift or nipple reduction

+2

In order to FULLY respond to the vague question you ask, I believe ONLY an in person evaluation with another boarded Plastic Surgeon or return to the previous 3 with these questions. You first must explain your wishes. Than you must understand terms. Are you concerned about the diameter and asymmetry of the areolae or is the nipple projection your issue? Than are you concerned about the slope or pseudo ptosis or very slight hanging of your breasts? Next do you want fully upper pole filling of the breasts? Finally do you want scars on your breasts?

You first need to address these questions in your own mind and ask for guidance to see if your expectations are realistic for your desires. Dr. Rand has given you the treatment options as I would but I feel you still are not sure as to the results obtainable with these options. Be sure you understand what is being offered before proceeding on to an operation. A good informed consent is much needed for you, so there are no hidden surprises after the operation. As "I did not know this would happen". Please be careful.

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.