Pain and Downward Pointing Nipples After Breast Augmentation?

It's been three months since I have had Breast augmentation done. I had the implants put under the muscle however, the breasts are still sore and painful as well as the nipple. Sometimes the nipples almost point downwards and look very ugly--almost puffy. Also the top of the breasts itself is very hard, the profile doe not curve inwards at the top and then fall--it's more raised and hard. When I press on the hard part I can almost feel pushing the implant down. I understand the pain will go, and three months is still early for some, but I really, really am not happy with the hard raised look at the top of them. Is everything normal please?

Doctor Answers 12

Nipple pointing down

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While there are variations to a person's breast anatomy, a downward facing nipple in front of an implant usually means one of two things.

The implant could be too high relative to the nipple position. This places the nipple on the lower half of the implant when it is more appropriately position near the equator or even into the upper hemisphere and the bottom of the implant should sit at, or near, the inframammary crease or fold.

In this case, the implant needs to be moved down if it doesn't settle over time. This relates to the pocket made at the time of surgery.

The other possibility is that the implant diameter (assuming a round implant is used) is too wide (or the vertical height of the breast too short) for the breast. Here, there is a mismatch between the dimension of the implant and the dimension of the breast.

The pocket is necessarily the problem but rather the style or size of the implant. Here, the implant should be changed to one with a narrower base or a different style/shape.

Beverly Hills Plastic Surgeon

Breasts may not have settled yet

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It sounds like your breasts haven't dropped and settled into their final position yet. An abnormal shape iand nipples pointing downward often indicates that your tissues have expanded and the implants are still being somewhat compressed. Usually, it takes about 3-4 months for the implants to drop. Please ask your surgeon about a bandage wrapped around the top portion of your breasts. This may help the dropping process. However, if the pocket was made too high, then revision surgery may be required.

The nipples should not point down after breast augmentation.

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I am afraid I don't feel optimistic about your situation. Nipple soreness after breast augmentation almost always goes away. But I don't think your shape will improve. It sounds like the implants may be too high.

I would wait another 3 months, and then consider a revision. What we do in New York City is sit the patient up before the end of surgery (you are still asleep, of course). Then we check to make sure shape, size and symmetry are great. If they are not, we keep working. This approach takes all the guess work out.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

At this point, time is the answer

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This is a difficult medium to discuss these types of issues - it's much easier to give you good advice when you can be seen. Along those lines, I'd encourage you to get a second opinion even now postoperatively if you're not happy with what your surgeon is telling you. Hopefully, it will reassure you that you're on the right path.

There are two things that may be going on:

  1. You may be just slow to drop and once your implants do drop you'll be fine. Time is the only way to know if this will happen.
  2. The slightly more discouraging possibility is that you have a double bubble type deformity and your native breast tissue is falling off the end of the implant.

Double bubble deformity occurs with under the muscle augmentation when the patient has some of their own breast tissue, and there is a small degree of breast ptosis (droop) preoperatively.

The easiest solution to this problem would be to move your implants to over the muscle... This has its own issues (more rippling and palpability) but will solve some of your issues.

Robert Frank, MD
Munster Plastic Surgeon
5.0 out of 5 stars 43 reviews

Be patient, time should help...

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It’s very difficult to assess your current situation without pictures or a physical examination. Based on your history, I suspect that your implants have failed to drop. This process generally takes 3 to 6 months and may still occur. Unfortunately, if the inferior aspect of the breast pockets hasn’t been adequately dissected or has closed prematurely, additional surgery may be necessary.
Your pain and discomfort aren’t unusual and should get better with time.Your breast shape may be more problematic and, for this reason, consultation with your plastic surgeon is appropriate.Your surgeon should be able to formulate a treatment plan that addresses your concerns.

Nipples pointing down and implants to high

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It sounds like your implants have not descended the way that they should and since it has been 3 months they probably won't. Without examining you and speaking with your surgeon it is impossible to tell. I suggest follow up with your surgeon but ultimately you may need a revision. 

Implants too high

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Hard to tell without photos but it sounds like your implants are too high.  If the muscle is not fully released at the bottom then the implants will stay high since the muscle maintains the pocket hight and tight preventing the lower pole from rounding out and the implant settling in the appropriate position.  If this is the case the muscle may have to be released as part of a revision surgery.

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Painful and downward pointing nipples after breast implants

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I have found that the exercises illustrated in the video below are useful in getting your breasts implants to settle. Please review with your surgeon first

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Poor Surgical Planning

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Without photos it is difficult to determine exactly what the problem is but the nipples should not be downward pointing after surgery.

One of two things is likely going on: The implants have remained high because of an inadequate muscle release or a Mastopexy (breast lift) should have been recommended.

I would discuss this with your surgeon or get a second opinion. In most cases this can be fixed with a revisional procedure.

Lawrence Iteld, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 48 reviews

By 3 months you should see changes

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By 3 months your implants should be on their way to settling. It sounds as though you may need a revision of some kind but it does take time to see you final results. It is really difficult to give you an opinion without examining you or seeing you photos. I encourage you to visit with your plastic surgeon to discuss your progress and make a plan. Best of luck

Dr Edwards

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.