Can my misplaced areola complex be moved down? How extensive is the surgery and is skin grafting required? (photos)

Hello!  I recommend you meet in person with a board certified plastic and reconstructive surgeon. You will need a revision of the breast lift due to excess tissue in the lower poles (bottom of the breast). I believe once that is addressed, you will have a really nice result.

The nipple-areola complex cannot be moved down.  However, the breast can be reduced further, removing lower pole fullness.  This would have the effect of placing the nipple-areola more on the center of the breast mound rather than slightly higher than the breast mound as it is now.  

Thank you for your pictures and questions. An in-person exam is need to take some measurements but in principle, I would cautiously disagree with you. I do not think your nipples are high or misplaced. You have classic pseudo-ptosis. This is where the nipple is actually in the correct position, but the lower pole of the breast stretches and droops and make the breast appear ptotic and the nipple appear high. You need a revision of the lower portion of the breast with excision of the excess nipple-to-fold distance. Make sure you see a plastic surgeon who is board certified by the American Board of Plastic Surgery who understands these concepts and how to approach and repair them.Good luck!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

Your nipple location is probably okay but looks high because the breast tissue bottomed out. You need the size of your breasts reduced and the skin in the lower portion tightened. Trying to lower the nipple will be difficult and leave you with unsightly scarring.

You appear to have undergone a circumvertical breast lift.  This frequently results in bottoming out that you are experiencing.  You will need a revision of the breast lift.  The technique I recommend is The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.Best Wishes,Gary Horndeski, M.D.

Dear Knoodledge,
It is hard to tell for sure without an examination, but based on your photos, it looks like you would benefit from breast lift revision surgery.
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

Unfortunately, you are experiencing almost typical long term result after breast lift of heavy breasts. After some time, due to gravity, breast tissue descends in the lover pole, while areola/nipple stay in the same position. Next breast lift (which is what most of us would consider) will start same process from the beginning. However, if we do breast reduction significantly reducing volume of tissue and replace that volume with implant, gravity is not going to show same effect. In our experience, when treating large, heavy breasts, we first perform breast reduction (most of that is done with liposuction of breast tissue which is 70-90 fat), place a silicone implant underneath the muscle (dual plane) and complete surgery with a vertical lift. In person consultation with a board certified plastic surgeon with good reputation in breast surgery is recommended. Good luck.

Thank you for your question. Actually, the problem is not that your areolas are misplaced superiorly, it is just that no breast tissue was taken from the bottom of your breast, and you have significant bottoming out of your breast tissue. This scenario is quite common in patients with poorly performed breast lifting. In your case, after augmentation and a lift (mastopexy), having recurrent bottoming out of breast tissue and lack of upper pole fullness if breast tissue was not removed from the inferior pole of the breast at the time of the initial surgery.  A large proportion of my practice is dedicated to revisionary breast surgery, and I have developed technique over many years that I call "Reductive augmentation" in which I place a larger higher profile implant, suture the pocket-capsulorrhaphy, and removal of the excess of the inferior pole breast tissue. This will reestablish more fullness above your areolas and remove all the excess tissue below reestablishing the normal position of your areola on your breast mound. I published this procedure in the International Journal of Aesthetic Surgery two years ago. You are an excellent candidate for this.  Best wishes to you.

I concur with others that likely the lower part of the breast has stretched or bottomed out after the lift and now needs revision to remove more from the bottom which should help. I would think consultation with a board certified plastic surgeon would  get you squared away, Good Luck!

Thanks for your question and photos. You  need a breast lift revision to remove some tissue below the nipples in order to lower the nipples. This will also lift your breasts again. I recommend you consult a board-certified plastic surgeon experienced in this procedure to discuss your goals, examine you, and show before/after photos to give you a better idea of the type of results you can expect to get. Good luck!