If I Have Naturally High Nipples How Do I Avoid Potential Double Bubble?

I have been for consults for 4 board certified surgeons (2 in New York, 2 in Australia when I went back to visit family) and have received conflicting advice from different surgeons. I am 5'11 and weigh 135lbs. My bust is 35B and I would like to go to a D cup. Apparently my nipples sit quite high, I have high set breast folds and a wide gap. They would need to lower the natural crease? I have slight asymmetry also. Thoughts?

Doctor Answers 14

High nipples and implants

Having nipples well above the creases is advantageous in minimizing the risk of a double bubble deformity becasue you do not need to lower the crease and the crease is the best barrier to implant descent.  Forget cup sizes and go for the "look" you wat to achieve.  I would consider a moderate profile implant as wide as your chest wall dimensions would allow to get the best look for your starting point.

Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Nipple position is fine

You are not at risk of having a "double bubble" in my opinion. Looks like you will have a terrific result. I would go with a high profile silicone implant with the scar in the creae around 350cc. best of luck

Joshua B. Hyman, MD
New York Plastic Surgeon
4.7 out of 5 stars 45 reviews

Nipple position and double-bubble deformity

Unfortunately the answers I see here are adding to your "too many consultations" problem. One surgeon apparently doesn't realize that a true double-bubble deformity is caused by the lower edge of the pectoralis muscle and can't happen in a non-constricted breast if the implant is above the muscle. If the pectoralis muscle is properly released in a dual-plane and the inframammary crease level is controlled, you shouldn't have to deal with this. I suspect that the reason for concern is trying to get a too-big implant in to increase you to a chosen size that is not realistic for what you're starting with. The nipple position is within normal and the asymmetry is fairly common. The problem is that your breasts are relatively narrow and the gap between them is wide. This gap cannot be violated by the width of the implant on a first time procedure without risking deformity, and if the implant is too big relative to the base width of the breast, lowering the inframammary crease will have to be done to try to get the implant to fit and this risks deformity as well. Normally a properly fitted round implant that is high profile will increase the breast size about two cup sizes but not if the breasts are relatively narrow and have a wide gap. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Breast augmentation and double bubble

The majority of women have breast asymmetry and they are good candidates for breast augmentation. I think you are a good candidate for that procedure. Your nipples are in normal position, from the pictures you provided. The risk of double bubble deformity is  really low if done appropriately. You will need to address your concerns with an experienced plastic surgeon, bring photos of what you like to look, this will convey significant information to your plastic surgeon. The concerns that you mentioned including how to correct the asymmetry can be discussed during the consultation. 

Moneer Jaibaji, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews

What size implants?

The photos show that you are tll and slender. Your breasts are actually a bit spread apart so I think that is mor important than the position of your nipples, which to me look well positioned on your breast. I suspect that you would do best with high profile implants, otherwise I think that they will tend to fill out your breast too much on the sides. The only drawbak to this is that you might not get as much natural cleavage without a bra that you might desire. I would recommend choosing an implant with a diameter not much more than the distance between your nipple and the breast crease with your breast stretched upward. This will make it less like likely that you end up with disruption of your crease and the "double bubble" you are worried about. You should get a great result if you don't go overboard with size.

Ronald Schuster, MD
Baltimore Plastic Surgeon
4.9 out of 5 stars 77 reviews

If I Have Naturally High Nipples How Do I Avoid Potential Double Bubble?

It seems to me that you are an excellent candidate for breast augmentation.

The very fact that your nipples are located a bit higher on your breasts means that your surgeon would likely not need to lower your creases, as this would cause the nipples to appear even higher.

You are no more asymmetric than virtually anyone I see for breast augmentation.

The so-called double bubble is a rare outcome in experienced hands.

I think you are suffering from too many consultations and need to get on with things!

Good luck!

Eric Pugash, MD
Vancouver Plastic Surgeon
4.9 out of 5 stars 136 reviews

Lowering the IMF in breast augmentation

Hi there

You've got a long torso, and are tall.  High sitting breasts are advantageous in terms of torso and breast appearance.  There are no anatomic barriers to you achieving an excellent augmentation if you want to have that.  The IMF will not need to be specifically lowered, but it will descend slightly just due to the implant weight postop and that will be enough.  You are low risk for a double bubble deformity if the IMF is not lowered, and high risk if it is lowered.

My specific comment is to suggest maybe to aspire to a C cup not a D.  You have an ectomorphic physique, and a D cup will look i suspect like a "boob job" on your body rather than natural.  If you want that look, then fine, but I suspect D cup breasts on you will not look particularly natural, so if a natural result is desired, consider reducing your desired volume a little bit.

If you are prepared to do that, any of the other concerns you have around the breast shape should also evaporate.

Good luck!

Treatment of asymmetric breasts

Your posted photos show asymmetric breasts with the right breast smaller than the left and the right inframammary fold at a higher level than the left. The gap between the breasts is wide and the nipples point slightly out to the sides rather than straight forward. If you just put implants in the nipple divergence will likely increase. Therefore you would need different sized implants in each breast, lowering of the right inframammary fold and a skin procedure to handle the nipple divergence. Unfortunately there is no surgical procedure I am aware that can decrease the gap and give you natural appearing cleavage. Your case is not one of simply put in implants and go home so naturally different surgeons will have different approaches to achieve the desired goal.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

High nipples do not cause double bubble after breast augmentation.


1)  Judging by your pictures, I would say you have ideal anatomy for breast implants, except for the slight asymmetry.  The common problem after breast augmentation is implants that sit too high on your chest and look fake.  Having high nipples makes it easier to avoid this problem, because the implants can more easily be centered on your nipples instead of being above them.

2)  The "double bubble" deformity is caused by a technical error and can be avoided.  It looks like the fold under your left breast should not be lowered at all, and the right fold should be lowered very slightly.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Breast augmentation

each and every case of breast augmentation is slightly different. It is hard to tell from your photos what sized implant is best for you body. ie base diameter, distance from nipple to infra mammary fold etc. These measurements help guide a surgeon in picking out an implant best suited for your body. There are different style implants, different diameters which could permit correction of your concerns.

Different approaches are common in our field. Many different approaches will achieve good results. Feel comfortable with a surgeon, and stick with that person. Look at results, discuss with prior patient etc.

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 22 reviews

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.