Drooping Nipples After Breast Lift and Implants

I just had implants a week ago. I had a circumareolar lift and implants. I wanted my nipples moved, but they don't really seem to be moved. My implant is high right now and have the band, and am doing the message method my doctor said. When the implants settle, will my nipple come up a little more? My nipples seem to be pointing straight downward, not upward?

Doctor Answers 17

Nipple Position After Implants

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It sounds like the implant volume is still very full high on the chest.

As the skin and muscle in the lower pole of the breast relax, the volume in the implant will shift downward: this is what we call implants "settling."

As the "implants settle,"  the nipples will rotate upward.

Periareolar lift and augmentation

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Periareolar lifts generally give a small amount of nipple lift compared to lollipop or anchor type lifts.

One week after surgery, however, is a tough time for the patientas it is, and much too early to be assessing the final result! Very close and frequent communication with your surgeon may help you through this tough phase. Hopefully your implants will settle to the point you are happy with the nipple position.

Occasionally, patients find that their nipple position is too low after complete healing of the surgery; in that case a reassessment may be in order.

If the nipple is too far down due to drooping, or the areola is too large, it may be better to raise the nipple (and reduce its size) with more powerful techniques rather than lower the implant onto the stomach to create the illusion of a properly positioned nipple.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

Healing will occur for up to 6 months, be patient.

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It’s not unusual for patients to have superior displacement of their breast implants in the immediate postoperative period.This is even more likely when larger implants are utilized.In some cases, this can give the appearance of the nipples pointing in a downward direction.This occurs for a variety of reasons including spasm of the pectoralis muscles, skin tightness, and swelling.

Improvement in this condition may be seen as early as two weeks following surgery but in some cases, may take several months to occur.In an effort to minimize this problem, many plastic surgeons utilize a superior breast compression band.This device forces the implant in an inferior direction which keeps the inferior breast pocket fully expanded.In addition to this maneuver, it’s important to avoid under wire bras and push-up bras in the immediate postoperative period.These devices have the potential to superiorly displace breast implants.

It’s important to realize that you’re still relatively early in your postoperative course and continued improvement is likely.If your breast implants are still superiorly displaced after six months, more aggressive maneuvers may be necessary.In most cases, this involves expansion of the inferior breast pocket with a procedure known as a capsulotomy.When the implant drops into normal position, the areola’s should rise relative to the implant.

If you’re concerned about implant displacement and inferiorly positioned nipple areola complexes, consultation with your plastic surgeon is appropriate.Your surgeon should be able to evaluate your situation and hopefully reassure you.

Nipple position after breast lift with augmentation

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In the early post-operative period, such as 1 week, after breast lift with augmentation, it is not uncommon for the implants to appear high and therefore the nipples pointing downward. This is particularly true if the implants are placed under the muscle. Implants will "settle" over the first few weeks and this will correct the appearance of nipple position.

Olivia Hutchinson, MD
New York Plastic Surgeon

You are likely to need a more extensive lift and a possible repositioning of the implant to above the muscle

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It sounds to me like your surgeons' choice of lift is inadequate for the nature of your breast anatomy.To place the nipples in a higher location a lollipop or anchor lift is needed. i will also assume that your implants have been placed beneath the muscle and this placement is the reason the implants appear high. It is possible that in the next  few months your implants will descend and come into a better relationship with your nipples.

However, even if the implants settle this will do little to raise the nipple, Unfortunately, it is not a forgone conclusion that this settling will occur even with the help of the elastic band.If after three months your implants still appear high then I would advise revisionary surgery. Employing one of the two lifts mentioned previously will raise the nipple and possibly eliminate the high implant look. It also may be necessary to reposition your implants above the muscle if the additional lift alone fails to solve the high implant problem. Your implant can be placed with impunity above the muscle if your original breast size was at least a B cup.

David A. Ross, MD (retired)
Chicago Plastic Surgeon

Nipple position after breast lift with implants

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After a breast lift with implants, the patient should expect to see swelling and malposition of the breast implants initially. Depending on the technique that was used many times the implants can appear to be much higher than where they will ultimately settle. This is common after a breast augmentation as well. Be sure to closely follow your plastic surgeon's postoperative advice. Many plastic surgeons will recommend using a special compress abroad with a  bra band to help the implants heal in the best position. However, after your healing process has completed, and you are still unhappy with the final position of the nipples there are options to practice. You may be a candidate for a small procedure where the nipple is repositioned into a more attractive position. The combination of a breast lift with implants can be very challenging and some surgeons performed the surgery in two stages for this reason

Breast Implants and nipple position

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Most likely the nipples are in a good position. They are pointing downward because the implants are high They should come down and the nipples should look ok.

With settling of the implants the nipple position will improve

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You should notice improvement with the nipple position as the implants settle.  This is because the implants should drop down so the nipples will be better centered over the implants.  However, if you post pictures, we may be able to give you more specific advice.  Good luck. 

They will improve

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A circumareolar mastopexy is a great operation if the nipple only needs to be move 2-2.5cm. If greater movement is needed than a circumvertical mastopexy is needed. When an augmentation is performed with a mastopexy the implant helps to move the nipple vertically about 1cm.

In the operating room the implants are placed then the nipple position is determined and the mastopexy is performed. Although the breasts will look greast "on the table" postoperatively the implants will tend to "ride high." However, with the bra and strap the implants will fall by about 3 weeks.

So continue wearing the bra and be patient.

Many of these issues will resolve.

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To reiterate: you had an augmentation and a lift through an areolar incision. The implants were put in through this incision. You are now concerned because the implants are high and the nipples point down.

The implants will come down and the nipples will corespondingly come up. There may be a bit of laxity in the the nipple/areolar tissue which may (or not) resolve. Time will tell. I agree that a bit of patience (2 to 3 months) is advisable. All the best.

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.