Follow-up Question: Do I need my pocket lowered or my nipples lifted? (photos)

This is a follow up question to a question I asked last week. I had my 3 month post op checkup today. My surgeon thinks instead of my implants being too high, that my nipples are too low. He's thinking he would do a crescent lift to move my nipple up and leave the implants where they are. He won't do anything until I'm 6 months post and he's willing to do either revision I decide. I don't have capsular contracture and I have healed well. What do you think is the best revision option?

Doctor Answers 9

High Implants

You implants are still too high.  You will need to have the inferior muscle attachment or scar to be released.  I do not recommend lifting the nipples/areola.  I recommend an in-office examination as well as a detailed discussion with a board-certified Plastic Surgeon certified by the American Board of Plastic Surgery.
Best wishes!
Dr. Desai
Harvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Pockets lowered

Yes, your implants are too high on your chest wall.  Lowering them so they are centered or slightly below your nipples would give you a nice result.  Best wishes, Dr. T

Breast implant revision

Your implants appear to be fuller up top however you are too early in the recovery phase to rush into doing anything else. I would wait

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 14 reviews

Dr Kayser

Thank you for your question. This is all about relationship between the position of the implant and the breast. It also has to do with the anatomy of each patient's breast and the position of the breast on the chest which is referred to as the footprint. This ultimately is identified by the placement of the infirmary fold and is usually not a movable landmark. The degree of drooping over the fold will determine what the nipple position is and in patients who are lower, they may require a breast lift which would necessarily require an external scar around the areola. In patients who have a short distance between the fold and the nipple, however, a different situation exists as this often represents what is referred to as a constriction deformity and can limit the expansion of the lower portion of the breast and inherently tend to push the implant higher than it should be. This is particularly seen in patients whose implant volumes exceed the natural boundaries of the breast.In your case, it appears that you have a tight fold with a short nipple to fold distance which is restricting the expansion or stretching of the lower portion of the breast and is pushing the implant too high. A breast lift will not correct this problem. Your best solution would probably be to wait in which extra time would allow the skin envelope to stretch. If this occurs, the implant may drop, however, the formation of natural scar around the implant during this time which is called a capsule, may prevent further dropping of the implant into the bottom portion of the breast. If this happens, you may require revisional surgery in which the scar tissue can br released and with a new implant, further stretching of the breast can occur and a more youthful position may result in allowing the implant and breast to establish proper relationship. One final concern would be that if you over release and expand the lower portion of the breast and disrupt the natural fold position, a double bubble deformity can result. In any case, I would certainly agree with waiting 6 months or more to see if further Improvement occurs. I hope this helps and have a wonderful day. Dr. Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
4.9 out of 5 stars 31 reviews

Revision Breast augmentation

I agree your breasts are high riding,  at three months this is usually a result of incomplete release of the muscle and attachments  at the Inframammary fold but an in person exam would be needed to fully evaluate..  I don't think a crescent lift is the answer.  Have you been wearing a bandeau?  If your breasts  are soft this could help.  A second opinion with a board certified plastic surgeon would be helpful. Good luck.

William Koenig, MD
Rochester Plastic Surgeon
4.8 out of 5 stars 54 reviews

Revision

Your issue will not be adequately addressed with a minor crescent lift. It will create more scars and possibly distortion of your breast and still not adequately address your issues.  And it may burn a bridge for definitive correction at a later time. You require a more extensive discussion before having revision surgery which should include multiple options including changing the implant style to one which is less tall but maintains projection, a breast lift, lowering of the pockets, etc. You may want to seek out another opinion from someone in your area who performs a considerable amount of breast surgery and breast revision surgery. Good luck! 

Brian S. Glatt, MD, FACS
Morristown Plastic Surgeon
5.0 out of 5 stars 43 reviews

Implant issue

Just based upon your photos, your implants still look a bit high and I wouldn't rush it. You might want to give it another 3 months or so.

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

Follow-up Question: Do I need my pocket lowered or my nipples lifted?

Without examining you I cant be entirely sure but it looks to me like the implants are sitting too high. I'd suggest getting a second opinion just to be physically examined by someone else. Hope that helps

Mathew A. Plant, MD, FRCSC
Toronto Plastic Surgeon
5.0 out of 5 stars 21 reviews

Board certified plastic surgeon

Please seek out a board certified plastic surgeon with years of experience for a second opinion. I am not sure your doctor has a complete understanding of your problem. Good Luck!

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 55 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.