Why are my nipples very high after breast augmentation? 2 months post op. (photos)

Question

I got silicone implants in June of this year. My nipples are very high and pops out of my bra. Is this normal and how can I get it fixed?

Luke J. Curtsinger, MD · Answer

It appears as though your implants have migrated down the chest wall, causing bottoming out.  This occurs when the dissection (from the surgery, massage or just gravity) gets below the ideal spot for the inframammary fold.  Discuss options with your PS.

Paul Vitenas, Jr., MD · Answer

Thank
you very much for your question and photographs. Unfortunately, from your
pictures, it appears that you are ‘bottoming out’. This means that your
implants have fallen within the breast pocket, now below the inframammary
crease. This will require a revision breast augmentation procedure to reposition
the breast implants. Often, surgeons will add additional support for the
implant using a dermal matrix, such as Strattice. My recommendation is to
schedule a visit with your operating surgeon, or arrange to see a new, board
certified plastic surgeon in your area. He/she can perform an in-person
evaluation and explain all of your options for correction.

Leo Lapuerta, MD · Answer

Thank you for sharing your photos.  It seems that your implants have bottomed out.  In this case, a revision surgery would be required.  I would contact your surgeon and discuss the next option with you. Best of luck !

Martin Jugenburg, MD · Answer

Thank you for your question. Please see your plastic surgeon about your concerns. An in-person assessment is best. Regards,

Christopher J. Davidson, MD, FACS · Answer

Thank you for your question and photographs.  Your photograph indicates that you have what is referred to as "bottoming out" where the implant falls below the infra-mammary fold.  My advice is to follow up with your plastic surgeon to discuss your result.  Best of luck.

Edwin C. Pound, III, MD · Answer

Based on your pictures, it appears that your implants have "bottomed out."  By this, I mean that the bulk of your implant is sitting below your nipples rather than being centered behind them.  This can be corrected by reconstructing the natural crease below your breasts at a higher level.  Sometimes additional material (Alloderm, Surgimend, FlexHd, etc.) may be needed to add additional support and prevent this situation from occurring again.  Unfortunately, I suspect that efforts to elevate the crease under your breast is going to result in your current surgical scar being located more on your chest wall than in the crease or under the breast.  This is one of the reasons that I do not like this particular incision.  You can move the crease up and give you a better shape to your breasts but you can't move the scar up.

Jeffrey E. Schreiber, MD, FACS · Answer

It appears as though you'll need an internal lift in order to close down the pocket on the inside to lift your implants.  I have done this before and it is great for centering the nipples and lowering them.
Thank you for your question!
Dr. Schreiber, Baltimore plastic surgeon

Gregory A. Buford, MD, FACS · Answer

From the photos you provided, it appears that you have developed bottoming out of your breasts.  This occurs when the breast fold is compromised and the implant essentially shifts down below the native fold (or where the new fold was supposed to be).  Several things point to this:Long distance from breast fold to the nipplesHigh-riding nipplesBreast incision above the breast foldThis is really something that you should address with your Plastic Surgeon.  It can generally be fixed by the following:Tacking down the breast foldPossibly supporting the breast fold using an ADM graft (e.g.:  Strattice or Alloderm)Possibly reducing size of the implants to reduce overall weight on the foldI hope this helps and wish you the very best!-Gregory A Buford MD FACSBoard Certified Plastic Surgeon

Daniel Barrett, MD · Answer

Hi Kristavee, 
  
Thank you for the question and the photos. I understand your concern. Based on your photos, it appears that you have developed bottoming out of your implants.
  
Bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery. 
  
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies. 
  
If you are concerned, please check it with your plastic surgeon. This way, your plastic surgeon can discuss further the best approach to resolve your concern. 
  
Daniel Barrett, MD, MHA, MS
  
Certified, American Board of Plastic Surgery 
  
Member, Am. Society of Plastic Surgery

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs. Unfortunately you have developed "bottoming-out" of your implants.  This occurs when the implant slides too low on your chest causing a lengthening of your nipple to fold distance which exposes your incisions and raises your nipple position.  Unfortunately the only correction will be with surgery to tighten the lower portion of each implant pocket so that the implant sits higher on your chest, centered behind your nipple and areola. Be sure to see an ASPS board certified plastic surgeon in consultation to discuss.

Why are my nipples very high after breast augmentation? 2 months post op. (photos)

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