Nipples placed too high on chest wall. Bottoming out. Too heavy. What should I do? (Photo)

24 yrs old female pre op 32 A Post op 500cc high profile gummy implant behind the muscle wall. since my surgery in April 2013 my nipples always pop out of my shirts or bikini tops and my breast on the left side feels like it is very heavy and could possibly be getting worse 3 months after my breast augmentation I noticed the left breast was very firm and did not drop like the right breast. MY ps said it was a contracture and I had surgery to correct. What should I do I am not happy

Doctor Answers 9

Nipples placed too high on chest wall. Bottoming out.

I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are appropriate; your breast implant does seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”).

It is possible that you are feeling the implants significantly along the lower poles of the breasts.  Also, consistent with the breast implant positioning problem, the nipple areola complexes seem to be sitting relatively high, because the breast implants have settled too low. 

I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation. 

In my practice, this type of repair involves a two layer, permanent suture repair (reconstructing the inframammary fold areas). Sometimes, depending on the clinical situation and history, the use of additional support materials such as acellular dermal matrix or biosynthetic mesh is also helpful.

 I would suggest that you communicate your concerns again directly with your plastic surgeon. Working together you arrive at the best plan (for example to operate on one or both breasts) to achieve an outcome that you will be happier with.
I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.

Seek A Board Certified Plastic Surgeon

Thank you for your question! It is best to go see a board certified plastic surgeon and get his or her opinion.  Best of luck!
Dr Dhaval PatelDouble Board Certified Plastic SurgeonChicago Hoffman Estates Oak Brook

Dhaval M. Patel, MD
Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 79 reviews

Bottoming out

It appears as if the breast implant is now too low, making the nipples appear to high on the breast. The nipples are definitely not too high. It is an implant problem. Raising the IMF and moving the implant higher will improve the problem. This is straight forward and your PS can give you all the options. Good luck. 

Robert Graper, MD
Charlotte Plastic Surgeon
4.5 out of 5 stars 26 reviews

I feel like I'm too round, and my right breast is different to the left one. What can I do? (Photo)

Appears as a very nice result. But best to seek in person second opinions for all your issues..................

Bottoming out

It looks like your implants are bottoming out and that is why your nipples appear too high. Best to get a revision and adjust the pockets and probably implant size.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Nipples placed too high on chest wall. Bottoming out. Too heavy.

Several problems may be going on here. The "gummy bear" implants are already firmer to start out. It is worsened by capsule contracture. The capsule contracture from the upper half of the implants together with the heavy weight (1 and 1/4 pounds each side) makes the implant more likely to bottom out. You may wish to consider smaller implants (as one surgeon had pointed out),, and possibly need to reattach the bottom of the implants better and capsulotomy. Best of luck.

Neil T. Chen, MD
Albuquerque Plastic Surgeon
4.8 out of 5 stars 72 reviews

Nipples appear too high

Nipples are not "moved" during a breast augmentation procedure. Your nipples simply appear to be too high because your implants have been placed or settled into a pocket that is lower than ideal. You will certainly need a revision to address the position of the implants. Please convey your concerns to your surgeon or else seek out a second opinion from a plastic surgeon who is board certified by the American Board of Plastic Surgery. Good luck!

Robert Galiano, MD
Chicago Plastic Surgeon
4.8 out of 5 stars 31 reviews

Nipple is now too high after implants.

When an implants sit low or bottomed out, the point of projection is below the nipple and gives the appearance that the nipple is too high or looking up. There are solutions that will repair the pocket to hold the implant higher in the pocket. We think that you might be better with a much smaller implant as well, and a moderate profile, and not a gummy for a softer more natural breast.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.1 out of 5 stars 40 reviews

Nipples placed too high on chest wall. Bottoming out. Too heavy. What should I do?

From your side view picture, it looks like you had a constricted breast deformity preoperatively. The periareolar tissue is protruding out into your nipple. It also looks like your lower pole skin has stretched letting the small diameter high profile implants sit lower on your chest which causes your nipples to come out the top of your swimsuits. Your capsular contracture could also be worsening this too.
It really requires an in-person consultation to determine the best course of treatment, but a larger diameter implant (which can be accomplished by going to a lower projection for the same volume) will help give you more upper pole fullness. You may also need the inferior pockets tightened and capsule release superiorly, but again, that is difficult to determine from your pictures alone.

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.