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Nipples Below Crease: Breast Lift and Implants or Implants for Me?

asked 1 year ago by liftmeup
Latest answer by Matthew Schulman, MD
Question viewed 1,308 times
Tags: breast feeding, comparison, lift

I am scheduled for breast augmentation and TT in a couple of weeks. I am 5'7 and weight about 150. I breast fed two children and it really shows. I asked my ps about a lift w/implants vs just implants and she acted like I could go either way. I had always heard if your nipples were below your crease then you should get a lift. I would rather go with just implants but if I'm going under I want to get it done right. I would love your expertise.

28 answers to Nipples Below Crease: Breast Lift and Implants or Implants for Me?

+4

Breast lift or Augment?

Based on your photo you have pseudoptosis or glandular ptosis (your nipple is at the infra mammary crease but a portion of the breast hangs below it). In that situation I would agree with your surgeons opinion, you could use either approach. In my own practice, simply adding volume to the breast with an augment will markedly improve the shape and appearance of the breast without the need for any additional scarring from a breast lift.
Mark Preston, MD

Columbus Plastic Surgeon
+4

Lift plus Implants or Implants alone are both reasonable options.

If you place a pencil beneath your breasts at your IMC (inframammary crease), I suspect your nipples will actually be at or slightly above the line made by the pencil. This makes you what I term a "borderline" case. Since the answers by my colleagues indicate that there is no clear-cut consensus, and either approach will likely yield good (but different) results, more information is needed (and of course, a physical examination gives any surgeon an advantage in making a good... more
Richard H. Tholen, MD, FACS

Minneapolis Plastic Surgeon
+3

It doesn't look like you need a mastopexy

Dear pickmeup, From your photos, I would agree with your PS. You could have a perfectly good result without undergoing a mastopexy. It just depends on whether or not you want the nipple position to be higher on the breast mound. If you don't have the lift, the implants will settle over time and look fine; keep in mind that it may take more time than a higher positioned nipple because the implant has a slightly longer distance to travel. If you are not really thrilled with the idea of... more
Lawrence Tong, MD

Toronto Plastic Surgeon
+3

Breast Lift with or without Implants

The simultaneous use of implants with breast lifts deserves careful reflection. First, you need to clearly define and communicate your goals and expectations. Adding volume to your breast with an implant will create a limited degree of lifting which may or may not  suffice to fullfill your aesthetic goals. The obvious advantage here is only a small implant placement scar. If you desire more substantial lift, you will have to consider the trade-off of breast... more
Stephan Baker, MD

Miami Plastic Surgeon
+2

Lift vs implants

This is a tough call.if the nipple is at or slightly above the fold I recommend a breast aug.You will age and eventually may need a lift but why create all that additional scarring when it is not necessary.Remember once you cut and get the scar there is no turning back.
Robert Brueck, MD

Fort Myers Plastic Surgeon
+2

An implant alone should do the job.

Judging from your photos I would recommend you go with an implant alone. The amount of lift that you would achieve from any lift  procedure would not justify the additional scarring. I would also recommend that your implant be placed above the muscle. Your implant can be positioned in this location because you appear to have enough breast tissue to adequately camouflage the implant without the need for muscle coverage. Placing the implant above the muscle will also in itself provide a... more
David A. Ross, MD

Chicago Plastic Surgeon

www.thecosmeticsurgeryinstitute.com

+2

You may be able to avoid a breast lift.

We take several factors into consideration when deciding whether or not to do a lift such as the degree of skin laxity, poition of the nipple, size of the implant among others.  Looking at your pictures it appears that you have lost some volume of the breast and this does contribute to looser skin. However, the nipple is relatively well positioned on the front of the breast.  For older women this is age appropriate.  You can have a natural result with an implant alone... more
James H. Schmidt, MD

Sarasota Plastic Surgeon
+2

Nipples at or below crease- Implants or lift and implants

Your surgeon is right, you could go either way.  When the decision is borderline, I feel that it's better to perform less surgery and see how things heal.  In your case, the periareolar lift could be done in the future under local anesthesia if necessary.
Kenneth L. Stein, MD

Chicago Plastic Surgeon
+2

Nipples Below Crease: Breast Lift and Implants or Implants for Me?

From the looks of your photos, I wuold recommend going with implants only.  You can always have a mastopexy later if you want your nipple higher- and you can do this under a local anesthesia!
Amy T. Bandy, DO

Newport Beach Plastic Surgeon

www.drbandy.com

+2

When is a lift necessary with implants?

There is no simple rule such as, "if your nipples are below the crease you need a lift." It depends upon the tightness of the skin, the size and shape of the implants, and your goals from surgery. With larger implants, the skin envelope is filled out more and there is some rotation of the nipples into the correct position. Depending on the implant size, this can be quite an improvement. For many women this is enough. If you desire more of a lift, it can always be done later.... more
David Bogue, MD

Boca Raton Plastic Surgeon
+2

Breast implants

As you can see, this is a very tough subject to give one exact opinion, as there are many.  A reason is that everybody wants a "perfect" result and there is not one!  People want to avoid too much scarring.  Your photos can indicate either a lift (along with augmentation), or augmentation alone.  This is an answer that your plastic surgeon's experience will dictate.  She alone will give you the best advice, since she is the one who has examined you.... more
Shahin Javaheri, MD

San Francisco Plastic Surgeon
+2

Breast augmentation together with breast lift

Make sure the TT is done before the breast surgery even if it is done at the same surgery to avoid breast distortion from the downward pull in the abdomen. On the side view your nipples are above the inframammary folds so technically you do not have ptosis. In order to give you an appropriate answer we really need to know measurements (breast base width, sternal notch to nipple distance, nipple to fold distance, midline to nipple distance), whether you want implants above or below the muscle... more
Aaron Stone, MD

Los Angeles Plastic Surgeon
+2

Do I need a lift.

Thanks for the pictures.  I think by your pictures it appears your nipples are at and may be even slightly above your crease.   An augmentation in a dual plane position, with only the upper half of the implant under the muscle, can lead to an acceptable result.  On the other hand, I think your result could be improved with a peri-areolar mastopexy.  The implant can be placed through the areola as well.  On my website you will find videos explaining... more
Vishnu Rumalla, MD

Dallas Plastic Surgeon

tarrantplasticsurgery.com

+2

Benelli breast lift with implants works great.

Hi. 1) I don't think it is a good idea to have the patient make a highly technical decision like this. 2) Judging only by your pictures (remember, I have not examined you), you will have the best result with a combination operation which includes a minimal scar breast lift. 3)  The breast lift is done just with a circular scar at the edge of your areolas, where the skin changes color. This scar is inconspicuous and fades with time. 4)  Then, we use smooth walled... more
George J. Beraka, MD

Manhattan Plastic Surgeon
+2

Choosing a augmentation or a lift or both.

If you are happy with the position of your nipples and you wish to simply increase the volume of your breasts then a simple augmentation would be your best choice.  This will provide volume only.  If you wish to have the nipple/areolar lifted to a perkier position and a better shape to your breast then a lift would be in order.  Keep in mind this increases the incisions on your breast.  If you wish to have both a better nipple position and more volume in the breast then... more
Jeffrey M. Darrow, MD

Boston Plastic Surgeon
+2

Breast lift with implants, or not

You are correct in that breast lift is all about nipple position, as if the nipple lies just below the breast fold the implant will tend to push the nipple lower giving a rather 'mature' look to the breast. Based on your photos you are on the line, though I feel that the nipple is just above the fold. Remember the nipple is the center, not the areola for our measurements. You should do well with the implants alone, a good choice, and lift later if necessary. Best of luck... more
Peter E. Johnson, MD

Chicago Plastic Surgeon

www.peterejohnsonmd.com

+2

What procedure would be appropriate: A breast augmentation with or without a lift?

As you can see from the advocating of both procedures by several plastic surgeons, there is no one right answer given your "borderline" situation. To add to this confusion, the style of implant that you would be receiving can also affect the ultimate appearance and the greater or lesser need for a lift. That is, a higher profile implant may provide you with a more acceptable appearance versus a moderate or lower profile where the nipple position would be situated in a less... more
Steven Turkeltaub, MD

Scottsdale Plastic Surgeon

www.turkeltaub.com

+2

Augmentation alone or with Lift?

As you can see, there is no right or wrong answer, and it depends on what your expectations are, and what you would like your outcome to be.  Keep in mind, a breast lift alone will not provide much long term superior fullness and will introduce more scarring and can be done later if desired.   
Stephen Delia, M.D.

Boston Plastic Surgeon
+2

Breast implants alone or with a lift?

I nearly always recommend implants alone if a reasonable result can be expected. A breast lift adds scars and expense. The combination of breast lift and augmentation is notoriously trouble-prone and can involve multiple revisions or touch ups. From your photos it would appear that you could obtain a good result with augmentation alone. I use the dual-plane approach which allows the implants to sit in the correct position behind the slightly drooping breasts. After surgery... more
Eric Pugash, MD

Vancouver Plastic Surgeon

www.vancouvercosmeticsurgery.ca

+2

Implants With/Without Breast Lift

You appear to be from your photos on the borderline of whether you can get a good result with implants alone or need a lift also.  If you are willing to accept some breast sagging, then I would suggest having an augmentation alone.  You can always undergo a small vertical lift later if you wish.
John Whitt, MD

Louisville Plastic Surgeon
+2

Implants alone or mastopexy with implants

Thank you for including a photo.  Every physician is different in their approaches and outcomes.  however, based upon your photo, it looks like you would be a candidate for implants alone or implants with a lift.  However, the outcome would differ with implants alone.  The post surgical appearance would be determined, in part, by the size of the implant you choose.  Implants, in general, will only lift the nipple 1-3 cm.  I would recommend an implant with... more
Jason R. Hess, MD

San Diego Plastic Surgeon
+2

To lift or not to lift? that is the question...

Your plastic surgeon is correct.  It is not wrong to proceed with a breast augmentation first.   Remember, your breast augmentation will help to lift up your nipple position by a little bit.   I would determine whether you would need an additional lift based on the amount and quality of any excess skin and your nipple position with respect to your overall chest wall anatomy.   Based on your photos, I would likely suggest just a periareolar mastopexy but I would definitely... more
C. Bob Basu, MD

Houston Plastic Surgeon
+2

Options for Surgery

Dear pickmeup, The whole goal of surgery is for the surgeon to create that which the patient wants to see.  Their is no wrong or right, rather their is the approach that will accomplish your goal.  Based on your photos, you would be a good candidate for either an augmentation alone, or a lift and augmentation. Each would produce a different result. You should meet with several plastic surgeons who can offer you both alternatives and explore with them what your results might... more
Marc Schneider, MD

Fort Myers Plastic Surgeon
+1

Breast Implants or Lift + Implants

I agree with the majority of my colleagues who say it can go either way. You should get an acceptable result with just implants. I think you wil get a slightly better result with a lift + implants, meaning that your breasts will look more perky and "youthful". There is a tradeoff...the scars of a lift. You need to think about what you would rather have - great outcome with scars OR pretty good outcome without scars? This may be simplistic but I think it is a good... more
Matthew Schulman, MD

New York Plastic Surgeon
+1

Implants or lift? focus on implant demensions and approach!

I would strongly recommend avoiding a lift. You have a very low inframammary crease with nipples exactly at the crease. Because your 'breast footprint' is low, it is tempting to recommend a lift but in reality this would be an aesthetic mistake leading to upward pointing strange nipples. Make sure that the implant selected is wider then your current breasts and do not have a lift. this will fill out your lateral deflation and give you some upper pole fill. the... more
Rian Maercks, MD

Miami Plastic Surgeon
+1

Breast lift with breast enlargement

I do a small lift, periareolar on the top side of the areola only on many of my patient such as yourself that have had children and their breasts sag a little. An implant will not uplift your breasts. My recommendation would be a periarelar cut through which I place the implant. I would recommend a silicone gel and on top of the muscle to get you the best cosmetic result. The size I want the patient to chose with my guidance. Check out our unbeatable allinclusive special price for breast... more
Edward J. Domanskis, MD

Orange County Plastic Surgeon
+1

Augmentation and/or lift

Patients that are borderline for a formal lift often do very nicely with a circumareolar lift which only places an incision around the border of the areola.  This may be the right thing for you, but a formal exam is necessary.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Breast Implants Do Not Lift The Breast.

The common thought is that a breast implant can lift the breast and a big breast implant can lift the breast more. This is false and when you think about it, how could that work? A breast implant in your breast will sit central on the chest and since your nipple is below your crease and you have a long chest, the implant will sit well above your nipple giving a "snoopy deformity", and a larger implant will only accentuate this and or lead to more sagging of your breast tissue. The... more
Andrew P. Trussler, MD

Dallas Plastic Surgeon

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