Why do you need to cut out the nipple and replace it further up to lift a breast?

Your concept that cutting out skin above the areola will lift the breast is not valid.  If the skin was capable of holding up your breast, you would not need a breast lift it the first place.  Instead, I recommend The Bellesoma Method.  This uses the excess skin to create an internal cone that transfers the weight of the breast to the underlying pectoralis major muscle.  This lifts the breast higher on the chest wall and provides a mechanically stable lift.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained.Best Wishes,Gary Horndeski, M.D.

Your question is an excellant one. In most traditional breast lifts, or mastopexy, although there is a scar around the areolae, the nipple is not cut out,  actually, it just moves up with rest of the breast tissue that was sagging. This places it back more centrally on the breast mound where it should be. There are a number of techniques used to accomplish this goal. One could perhaps use a incision located above the breast to perform the procedure, however as you have noted ,this would leave a scar that is not readily covered by many types of clothes, including bathingsuits.

Neither the nipples nor the areolae need to be REMOVED during a breast lift revision.  A breast lift does involve MOVING the areola to a more superior position. The surgical incisions are strategically placed to be as minimally noticeable as is possible. 

Dear adnarim,
my preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity. 
If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Many thanks for posting your question.You are right in principle, in that the techniques for breast lifts and reductions are all based on keeping any scarring below the level of the nipple.However, some of the scars in the lower part of the breast are also a result of techniques that help to re-shape the breast.I hope this answers your question!

The nipples are rarely cut off the breast, but stay attached. A new opening is made to house the nipple as the breast mound is lifted upward.

Thanks for your question adnarim.
In my practice, when performing a mastopexy, or breast lift, the nipple is not physically removed from the body and relocated, but in fact lifted whilst still connected to underlying tissue and vessels. An excision is made around the nipple with a superficial and wide layer of skin removed. The skin around the nipple is then sutured to the new location higher on the breast where they naturally should sit. This ensures the blood supply to the nipple is maintained and minimal complications will occur. The incision lines are placed in the most inconspicuous location possible to reduce their visibility.

Simply cutting above the nipple where you have indicated will not provide the desired results and potentially leave a very visible scar in its place.
Thanks again :)

Thank you for a very frequently asked question. patients often pull the  breast tissues upward to show me where they would like their nipple to be positioned.
The breast uplift scars are designed to be the most discreet and healing-friendly they can be without dragging of skin against natural tension lines. The procedure is also very cleverly designed to reshape the breast on its foundations and PUSH up and support the tissues that supply blood to the nipple. In this way you achieve a rejuvenated and shapely breast, a nipple that is supported and propped up on a cushion of underlying tissue that is reinforced like the keel of a boat and as gravity takes effect, the lower pole naturally curves downwards to give a lovely natural shape. Of all the plastic surgery procedures I perform, the breast reduction/uplift operation is the cleverest and the one I would love to have invented!
Hope that helps answer why plastic surgeons don't just cut an ellipse of skin from above your nipple to give an ugly scar that then gets stretched downwards by the weight of the sagging breast.
That being said, if only a little lift is required, an uplift can be achieved by hiding scarring around the areola...but again shape can be compromised (the top flattened) if a large lift is required.
So that's how talking to an FRCS Plast surgeon is helpful, you can discuss and agree shape, lift and longevity of result versus scar.
Rozina Ali FRCS Plast

Thank you for your question.  I understand the diagram can be confusing.  In general, the nipple is not cut off from the underlying breast tissue in order to preserve the blood and nerve supply going to it.  Only in very rare cases does the nipple have to be fully removed during a lift.  What we do remove is the skin around it.  We do this because many patients have nipples that sag much lower than where they should be.  A better way to picture what is happening is that the skin is dissected off the nipple and breast tissue, and then it is redraped to make a perkier, more youthful breast.

Hi thank you for your question. You seem to have answered your own question. The breast uplift is done in a manner to leave the scars as discrete as possible. If we were to simply remove the skin you have marked it would leave a very visible scar which is unlikely to be acceptable to most patients.Best wishes.