Wrinkles on nipple after breast lift (Photo)

Question

I’m six months post op, and I still have these “wrinkles” on the top part of my nipples, following a breast lift without implants. I thought they’d smooth out, but apparently they won’t. I’m told that this is “normal” when you don’t get implants, because of lack of upper pole fullness. However, I didn’t have them before, and on one side in particular, it seems to me a consequence of suture.

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here!pleating of the skin after a breast lift is not uncommon , since you are essentially bringing a bigger circle ( the breast incision) to match a smaller circle ( the areola). This usually disappears with time, you are 6 months out , scars can take around a year to settle and mature . I would give it a little more time , follow your surgeons instructions and if it doesn't resolve by then a simple revision can likely fix the issue.
I hope this helps, Best of luck!

Daniel Barrett, MD · Answer

Dear Petalo,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Emre Guvercin, MD, FEBOPRAS · Answer

What you’re seeing is not unusual, but it’s also not something you have to live with.Why these “wrinkles” appearAfter a breast lift without implants, wrinkles or creasing on the upper part of the areola usually happen because:The upper pole is underfilledThe skin envelope was tightened, but the breast tissue wasn’t redistributed upwardThe areola skin ends up sitting over an area with insufficient underlying supportThis is not because you didn’t get implants &mdash; and it’s not necessarily a suture problem, even if it looks that way on one side.Importantly, you’re right to say:“I didn’t have these before.”That tells us this is a shape/support issue, not a natural skin change.Do you need implants to fix this?No. Absolutely not.You already have enough of your own breast tissue to correct this.How this is actually correctedThe solution is a revision Push-Up Lift (supportive mastopexy).With this approach, the surgeon:Repositions your existing breast tissue upward to fill the upper poleRestores support under the areola (instead of tightening skin)Reduces reliance on areolar suturesAllows the skin over the areola to smooth out naturallyOnce the upper pole is properly supported, the wrinkling you’re seeing typically:Softens significantlyOften resolves completelyLooks much more natural and even between sidesWhat won’t reliably helpWaiting longer (at 6 months, this usually won’t self-correct)Massage or creamsSkin-only tighteningPeriareolar revisions aloneThese approaches don’t address the missing structural support

Gregory Lakin, MD · Answer

Thank you for your question. Wrinkles on the nipple area after a breast lift without implants can occur, especially when there is less upper pole fullness. This is because, without the extra volume provided by implants, the skin can sometimes fold or ripple due to how the breast tissue is reshaped and lifted. While this can be normal, you’re concerned that the appearance might be related to how the sutures were placed. Sometimes, if the sutures are too tight or placed in a way that pulls the skin unevenly, it can cause wrinkling around the nipple. Also, the wrinkling might be related to how the tissue healed after surgery. In these cases, a minor scar revision or adjustment of the sutures could help smooth out the area. Also, if you’re open to fat grafting or modest implants, this could reduce the appearance of wrinkles. However, you should discuss these options with your surgeon. They can assess the cause of the wrinkling in more detail and recommend the best course of action.

Chet Mays, MD · Answer

Thank you for your inquiry!  Skin laxity can sometimes cause wrinkles, as well as weight loss.  We would be happy to sit down and discuss your options.  Schedule a consultation with a Board-Certified Plastic Surgeon to help you reach your goals.

Matthew C. Camp, MD · Answer

You are right. This is a consequence of sutures. When the areola is down sized and lifted, there is a strong possibility of some gathers and pleats. These generally subside with massage and patience. Implants do help stretch the skin and minimize the wrinkles, but if you don’t want or need implants, don’t get them.

Ira H. Rex III, MD · Answer

I think that this irregularity may indeed be a consequence of suturing, and it may improve over the next year.  Excising the area and re-closing the wound may certainly improve the aesthetics, but it is probably too early to consider this.

Connie Hiers, MD, FACS · Answer

The wrinkles right at the scar edge are due to sewing and trying to gather in excess tissue. Your surgeon can now revise the scar for a smoother appearance. Micro-needling could also be helpful. For the wrinkles on the skin above the breasts, you can try micro-needling with radiofrequency, like Secret, for a smoother appearance.

James Knoetgen, III, MD · Answer

Wrinkling or puckering of the nipple/areola area after a breast lift can occur for several reasons, and it is often related to how the skin heals and responds to changes in tension, especially without the added volume from implants. Here's a breakdown of potential causes and solutions:
Potential Causes of Nipple Wrinkling Post-Breast Lift
1.	Tissue Tension and Skin Redundancy:
o	During a lift, skin is tightened and repositioned, and without implants, there can be a lack of fullness, particularly in the upper pole, leading to some puckering or wrinkling.
2.	Suture Technique:
o	If the wrinkling is localized near the incision line, it could be related to the sutures. In some cases, internal sutures cause tethering, leading to uneven healing or slight skin bunching.
3.	Natural Healing Process:
o	It may take 6-12 months for all swelling to subside and tissues to settle. However, since you’re at the 6-month mark, any remaining wrinkles may not completely smooth out without intervention.
4.	Skin Elasticity Issues:
o	The skin on the areola is delicate, and in some individuals, it may not smooth out completely, especially if there is minimal upper pole support.
Potential Solutions for Persistent Nipple Wrinkling
1.	Massage Therapy:
o	Regular scar massage or moisturizing massage (with silicone gel, Vitamin E oil, or cocoa butter) can help relax the tissue and encourage smoother skin.
2.	Laser Resurfacing or Microneedling:
o	Fractional laser treatments or microneedling can help improve skin texture by stimulating collagen production, which may reduce wrinkles and smooth out the area.
3.	Fat Grafting (Fat Transfer):
o	If the wrinkling is due to a lack of tissue volume, fat transfer can provide subtle upper pole fullness and smooth out the area around the nipple.
4.	Non-surgical Skin Tightening (RF or Ultrasound):
o	Treatments like radiofrequency (RF) or ultrasound-based therapies (e.g., Morpheus8) can help tighten loose tissue and improve overall skin texture.
•	Consult your surgeon: Since you mentioned one side may be a result of suture placement, it’s a good idea to schedule a follow-up. Your plastic surgeon can assess whether a minor revision would be beneficial.
•	Monitor changes: It’s still possible for some improvement over the next 6 months as tissues continue to soften and settle, though surgical or non-surgical interventions may be needed if the wrinkling persists.
If the wrinkling bothers you aesthetically, your plastic surgeon can tailor the most appropriate solution based on your anatomy and desired outcome.

Mats Hagstrom, MD (license on probation) · Answer

The wrinkles you describe are a result of a mismatch of the amount of skin on the outer skin compared to the amount of skin length on the areola.
When there is a mismatch, the surgeon will sometimes create a press string type closure, trying to win corporate the excess skin redundancy by making small folds, which you describe as wrinkles. If done correctly, this will even out overtime.
Breast reduction, part of the procedure is reducing the skin envelope.
This can be done anywhere along the incision and longer the incision the more ability the surgeon has to, remove excess skin.
The outcome it’s not dependent on having an implant or not, but simply how the procedure is performed.
If you look at other before, and after pictures, you’ll see that some may also have this, but most do not.
Best,
Mats Hagstrom

Wrinkles on nipple after breast lift (Photo)

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