Nipples too high, lost inframammary fold beneath one breast - how can this be revised? (Photos)

Question

I’m at a loss. My surgeon says my nipples aren’t too high, yet they’re falling out of every top I own. My poor father-in-law has now accidentally seen my nipples. I’m not sure which one of us this was worse for. I am also distraught that I lost the inframammary fold beneath my left breast. I was told the scar wouldn’t be visible.

Harry T. Haramis, MD, FACS · Answer

There will always be left to right breast differences before and after any surgeries. This would include lower poles, folds and nipple position.

A revision should be able to reduce the lower pole and shorten the distance from the nipple to the fold. This should lower the nipple height as well. Usually this is with a simple ellipse (football) wedge along the crease-fold. Should be able to improve symmetry of shape, volume, etc also.

Further discussion with your/a plastic surgeon is recommended.

Mert Demirel, MD · Answer

If your nipples are coming out of clothing and feel too high in daily life, your concern is valid, even if the position looks acceptable in certain photos. Nipple position has to be judged not only by measurements, but also by breast shape, fold position, clothing fit, and symmetry.
Loss or lowering of the inframammary fold on one side can make the breast look unbalanced and can change where the nipple appears on the breast mound. If one fold has been disrupted or the implant/breast tissue has settled differently, the nipple may look too high because the lower pole is too low or poorly supported.
Revision may involve recreating or reinforcing the inframammary fold, tightening the lower pole, adjusting the implant pocket, and possibly revising the lift pattern. In some cases, internal sutures or mesh support are used to help hold the fold in a better position.
Actually moving the nipples lower is not usually the main solution, because lowering the nipple surgically is difficult and can create new scars or blood supply concerns. More often, the goal is to rebuild the breast shape underneath the nipple so the nipple sits in a better position relative to the breast mound.
My advice would be to get a second opinion from a revision breast surgeon. Ask specifically whether the problem is high nipple position, low/lost fold, bottoming out, implant malposition, or lower-pole stretch. If the fold and lower pole are the issue, revision can often improve the balance, but it needs careful pocket and fold reconstruction rather than a simple scar revision.

Don W. Griffin, MD · Answer

Thank you for your question. Based on your pictures, I believe that more of issue is due to the small amount of breast tissue that you have in the upper breast and stretching of your lower pole skin than the nipple position. Your left breast has more excess skin than your right and I suspect that your inframammary fold heights are different anatomically. A breast lift does not change where the folds sit, just how much tissue is above or below the folds. Asymmetric breast remain asymmetric after surgery and some asymmetries become more noticeable once the sagging is corrected.
In your situation, a revision surgery to remove additional lower pole skin especially on the left side will improve your result. If you are agreeable to adding some upper pole volume with a small implant, this upper pole volume addition would help your bras fit better and make it less likely for your nipples to show.

Camille Cash, MD · Answer

I'm sorry you are having issues after your breast lift.  Based on the photos there is too much distance between the nipple and the fold.  A surgical correction would be needed for a more balanced look.  Visit with a board certified plastic surgeon near you to learn more.

Ralph M. Rosato, MD · Answer

It is not possible to give a definitive answer to your questions based on a photo. It appears that the implants are below the fold, (bottoming out). This bottoming out makes the  nipples appear to be too high. You may need mesh to support the lower part of the breast. Bring you original photos to your second opinion consultation.

Nipples too high, lost inframammary fold beneath one breast - how can this be revised? (Photos)

Answers (5)

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