Why Can't I Be the One to Decide Where my Nipples Should Be with a Lift?

25 yrs,108 lbs,5" 2. Nursed 4 bABES. 1ST pg I went from a perky B to torpeedo DDs w/ angry red stretch marks! I have been to three consults for a lift/augment and am becoming very discouraged. 1st said minimal lift w/ larger implant than I want to gain shape. 2nd said no lift w/ implant. 3rd said refuses lift and said implants would just make me sag further! My nipple is right at the level of the mamory fold and they say thatis right where it should be. I want it at least 1 inch higher! Why not?

Doctor Answers 20

Location of nipples with a breast lift

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As you can see from your consultations, there is not one single style that all plastic surgeons adhere to.

Placing the nipples a bit higher than may seem not too big a deal. 

However, if nipples are too high, and they peek over standard garments, including bikinis.  Patients end up being embarrassed and wear large "granny bikinis" to hide their exposed nipples.  It is sometimes difficult to revise too high nipples.

Also, some lifts and implants may bottom out in the future, so what may not be a problem now might become a problem in the future, for the reasons above.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

Nipple Position with Lift

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Ideally, we would prefer to place your nipple at the position the patient chooses. It would look great, right after surgery.

However, we know the breast and the implant will settle over the weeks and months after the lift. Though we can shape the breast and remove extra skin at surgery, we can't control skin elasticity - the resistance of the skin to stretch over time.  We don't have the ability to affect that quality of your skin, which is genetic and age-related.

As the breast settles after surgery, the new nipple position doesn't change: imagine the volume of the breast settling behind the nipple.  Even a small amount of this downward change in the breast fullness causes the direction the nipple points to angle upward. The result is that the nipple looks positioned and pointing too high on the final breast mound.  Some people refer to this as "bottoming out."  (To see what I mean, you can find pictures of "bottoming out" on breast implant websites.)

That's why plastic surgeons have learned that we should not place the nipple higher than the breast crease when performing breast lift.

Nipple Position after Breast Lift

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I can't say with certainty from your photo's, but based upon your description you have glandular ptosis (the nipple is at or above the infra mammary fold, but the breast tissue hangs below it). In that situation you have several options:

  • you can perform a breast lift with or without an implant
  • you can place an implant alone

There are pluses and minuses to each of these approaches, and you should have a careful discussion with your surgeon to weigh the options. In my practice I do not like to perform a lift on the same day as an implant so I would separate those procedures.

Mark Preston, MD
Columbus Plastic Surgeon

Who has a say in my nipple position after surgery?

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This is a decision that you and your plastic surgeon must decide together. The nipple should be in the most projecting part of the breast. If it is higher than that than it looks like your breasts "bottomed" out an the nipples point to the ceiling. If it is below the mound and points toward your shoes, it looks like you need a lift. You need to decide if you like the breast volume in a bra or you would like to be larger. With your small frame and thin skin with stretch marks, I would advise against large implants just to take up the skin looseness, because in about a year you'll end up with the same problem that you have now. I personally tend to place my nipple positions 1 -2 cm lower than the ideal placement, because I expect some "settling" of the breasts after surgery ( lift and/ or augmentation). Good luck.

Pick the breast volume first; then decide on nipple position.

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Yes, you should be in charge of what you want your breasts to look like.

If you want a larger cup size than you are now, bring in a bra of the size you want to be, and try different size breast implants in the bra to find the size YOU want ot be.

Then, given that there must be some losse skin and nipple descent after losing your pregnancy-stretched breasts, you can decide if you want the nipples to be higher and the breast skin or envelope to be mad tighter.

it should be all up to you to decide breast volume, nipple position and breast shape with the surgeon advising you on the surgery and resulting scars necessary to achieve what YOU want.

G. Gregory Gallico III, MD
Boston Plastic Surgeon

Breast Lift and Nipple/Areola Position?

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The decision of where to “place” the nipple/areola complexes with breast lifting surgery can be a decision made by patient and physician with good communication. In other words, there is some leeway as to what is an acceptable position of the nipple/areola complexes.

Typically, this positioning is determined by evaluating the position of the inframammary fold, positioning of the breast implants and other factors such as patient height and goals… For example, you will want the nipple/areola to be at a level above the inframammary fold ( but not too high);  you will also want the nipple/areola to be centered nicely on the breast mound.

Again, finding a plastic surgeon who you feel you can communicate well with his very important;  this communication will be a crucial step towards achieving your goals.

Best wishes.

Deciding Nipple Position in Combination Breast Lift with Implants Is A Joint Decision Between Patient and Their Plastic Surgeon

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The combination of lifting a breast and adding volume with an implant simultaneously can be a challenging procedure to achieve the ideal result. Deciding beforehand where one desires the nipple to end up on the mound afterwards helps determine what type of breast lift is needed and the amount of scarring that will result. Knowing what the scar tradeoffs are for the amount of nipple elevation desired is an important part of your presurgical education. When there is a doubt as how the nipple position may turn out or whether it is really too low, placing the implant first can be a good choice. A secondary breast lift can always be done when the effects of volume increase alone has become clear. 

Lift and nipple position

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Without an exam , it is difficult to say where your nipple should be. However, it does look a bit low, and I would caution trying to raise it too much, because it may fall out of your bra with implants.

Nipple position with lift

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I wonder the qualifications of whomever you saw. With proper planning and skill, it should not be very difficult to get you from the condition on the left of the pictures to that on the right. You need a small implant with a lift. You may be able to have only a vertical lift, but may need an infra-mammary incision. With a small amount of breast tissue and all the excess skin removed, the nipple belongs at least an inch above the infra-mammary crease (the bottom of the areola should be at least ½ in.). You cannot correct what you have without a lift. You need to see a Board Certified Plastic Surgeon with significant experience in breast surgery. That person should be able to do what you need.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Why Can't I Be the One to Decide Where my Nipples Should Be with a Lift?

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You can always have you desires but the surgeon must feel that what you want is unrealistic. Continue to see other boarded PS in your area. Regards Dr. Darryl J. Blinski

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.