Aureola Above the Bra Border Line? (photo)

Hi Dini,

     Based on your photos, this should be correctable.  It appears the distance from the top of your areolas to the bottom of your breasts is a bit long in relations to the projection of your breasts.  I also find that you still have excessive laxity on the side of your breasts from the profile view.Tightening your lift both in the vertical as well as the horizontal dimension should correct these issues.

Good luck,

Ary Krau MD FACS

 

The correction of this problem has a lot to do with the position of the inframammary fold after breast lift surgery.  You may require repositioning of the fold and further tightening to reduce the IMF to areolar distance. Raffy Karamanoukian, Los Angeles

   Your pre and postop photos show a very nice improvement, but a tightening of the skin envelope can remedy the problem with the bra. Find a plastic surgeon with ELITE credentials who performs hundreds of breast lifts each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Thanks for including photos; they are very helpful in showing me that your surgeon has done a very nice job in lifting your breasts. Nipple position appears normal in the post-op views, but measurements of the "exact" or ideal position are not possible except in person. Physical examination would also allow the examiner to evaluate the amount of nipple-crease skin and whether or not you have stretched this skin somewhat as you have healed, perhaps causing a mild-moderate degree of "bottoming out."

I'm sorry this has become a challenge for your clothing choices and feeling of exposure--this is a worthy concern and certainly NOT trivial. However, your surgeon is not to be blamed for what appears to be a really well-performed breast lift. Your skin elasticity (actually, the lack thereof) is also part of the issue here, and no surgeon can predict in advance how much stretch or additional loss of elasticity will occur in any individual patient. But neither is it your fault.

A productive attitude would be to simply ask your surgeon about a revision, anticipating that s/he would have discussed this policy before your original surgery. Most plastic surgeons would consider re-do surgery at no or limited surgeon's fee but patient responsibility for OR and anesthesia costs. This is both fair and reasonable, but each office will have their own policy.

Additional skin can be excised along the underside of your breasts, rotating your nipple areola complexes downward compared to your more superiorly-displaced breast tissue. This should solve or at least improve your clothing concerns. Best wishes! Dr. Tholen

While your result is very reasonable, your breasts have settled and bottomed out to some degree. A re-do of the breast lift (without cutting around or moving the areolas) will move the nipples downward back into the bra. This is accomplished because the horizontal excision of the skin along the inframammary fold will pull the lower pole of the breast inward which moves the upper part of the areolar downward a bit.

Your lift results look very good.  If all of your bras allow your areola to 'hang out', a reduction of your vertical pole will be needed to lower your areola position.  It can be a simple office procedure but it is temporizing as the breasts will continue to change with time.

As described the nipples are showing above the bra and the pictures show still some excess breast skin and tissue. Waiting 3 to 6 months after surgery and redoing the breast lift with removal of the excess skin both in a horizontal and vertical vectors should help resolve the problem as well as give even nicer results then you have.

Good luck!

Although your concerns are understandable, it does appear that you have achieved a very nice result with the breast lifting surgery. In order to improve your situation, additional tightening of the skin envelope may be very helpful. In other words, removal of skin along the lower poles of the breasts will help “centralize” the nipple/areola complexes better on the breast mounds, hopefully helping to prevent areola  “peekaboo” above the bra.

 Best wishes.

Thanks for adding the posted photos. 

I am not sure just looking at the after photos I would have anticipated the problems you have been having with the position of the areolas in a brassiere. 

The befores and afters themselves look like quite a nice result, although the areolas are a bit high, and that is presumably the cause of the issues with bras. 

I do think that this can be improved by removing some skin along the breast fold, which will further lift the breast volume some, and will also give some downward pull on the areola.

As to fees, that will vary from practitioner to practitioner. Often for a problem of this nature, the surgeon will do the procedure with no professional fee, and the costs to the patient would be limited to the costs of the operating room and anesthesiologist. 

All the best. 

The high nipple position after your breast lift certainly puts you within range of frequent wardrobe malfunctions.  In an ideal sense if the front of the breast was divided in thirds the nipple should cross between the lower two thirds rather than halfway up the breast.  Another consideration is the length measured from the breast fold to the lower edge of the nipple.  A length longer than 7 cm might cause the breast to appear ptotic (glanduar ptosis) and caused the nipple to appear higher on the breast proper.  Your high nipple position can be helped by removing skin in the lower portion of the breast to push the gland up behind the nipple and draw the nipple lower.  Let your surgeon see your photo you have posted. He is not likely to be happy with the result either.