1 year post-op: Nipples too high, implants separated. What are my revision options? (photo)

Dear Fabulous,

Thank you for sharing your experience so openly—your concerns are absolutely valid, and you deserve to feel both comfortable and confident in your results.

It’s important to first acknowledge that while breast augmentation can yield transformative results, perfection is not the natural standard—either in the unaltered breast or after surgery. Each breast has its own unique anatomy and response to implants over time, and asymmetries, positional changes, and tissue behavior can evolve as part of the healing process, especially beyond the one-year mark.

From what you've described—persistent discomfort on one side, visible asymmetry, loss of upper pole fullness, lateral displacement (often referred to as "bottoming out" or "implant malposition"), and high nipple position—there are several structural and aesthetic concerns that can be surgically addressed.

Here are some potential considerations:

Implant Size & Weight:
High-profile 480cc implants carry significant volume and projection. Heavier implants over time can contribute to stretching of the lower pole and descent of the implant pocket, especially if your native tissue lacks sufficient support. Downsizing your implants would reduce mechanical strain on the lower pole and soft tissue envelope, which may improve comfort and long-term stability.
Inframammary Fold (IMF) Management:
The sensation of "heaviness" and your description of lower pole fullness suggest that your IMF may have descended. A capsulorrhaphy or IMF reinforcement (possibly with internal suturing or mesh) could be performed to re-establish support and reposition the implant superiorly. In cases with considerable tissue stretching, tissue excision from the lower pole can be necessary to shorten the vertical breast length and restore proportion.
Nipple-Areolar Complex (NAC) Positioning:
A high nipple appearance in relation to the breast mound typically results when the implant drops or the lower pole lengthens. If you're considering downsizing, the nipple may appear even higher on the breast mound due to reduced projection and footprint. In such cases, a mastopexy (breast lift)—ranging from a periareolar to a vertical or even Wise-pattern—may be necessary to re-center the nipple in a natural and aesthetically pleasing location.
Implant Pocket Concerns & Cleavage:
Difficulty achieving cleavage and a "circular" look can be attributed to over-dissection laterally, thin medial tissues, or improper implant selection. Revising the pocket (medial capsulorrhaphy or switching to a moderate profile implant) may help create a more natural slope and cleavage.
Your Next Steps:
I strongly encourage you to consult with several board-certified plastic surgeons, ideally those with experience in complex revision breast surgery. A detailed in-person evaluation, possibly with 3D imaging, will provide you with tailored options based on your unique anatomy and goals.
Revisional breast surgery requires a delicate balance between form and function, and a conservative, thoughtful approach is always best. Please don’t feel discouraged—many of these concerns are correctable, and your desire for a more natural, proportionate result is achievable with the right plan.

Respectfully,
Earl Stephenson, Jr., MD, DDS, MBA
ESJ Aesthetics

Thank you for your question. You might need a revision surgery with implant exchange to a lower profile implant to balance the size, improve symmetry, and give you a more natural look. Also, your surgeon may need to repair your pockets inferiorly and laterally and dissect the upper pocket to allow the implants to sit higher. Consult a board-certified surgeon specializing in breast revision surgery to assess your case and ensure the action for your desired outcomes.

A high profile implant will create a more unnatural, rounded look. You have some slight inferior malposition. I would recommend tightening the pocket, placing internal support (Galaflex), and performing inferior mastopexy (to shorten the nipple-to-fold distance). You need a very experienced American Board of Plastic Surgery certified plastic surgeon.