Had a breast reduction and now my areola and nipples are too high - what are my best options? (Photos)

Star gazing NAC/too high is a challenging issue to correct. Actually lowering the NAC will leave a scar above the areola.

The best option is excision of the lower pole in the hopes of drawing the NAC downward as well as shortening the nipple to fold distance. It creates the illusion of improved position without actually lowering the NAC.

This is by no means a solution but can be helpful by offering a more balanced appearance. The 45/55 rule suggests for optimal placement 45% or the breast should be above the NAC and 55% below (i.e. the nipple should sit slightly lower than the midpoint of the mound.

Based on your photos, the ratio of breast the NAC is too large. Direct excision can address this imbalance.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

A revision would be needed to remove some of the extra tissue at the bottom of the breasts. I've included a video that specifically addresses the incisions. You can consider implants to add volume. Another option is auto augmentation. This approach uses your own tissue to create more upper pole fullness. This is different than fat transfer and does not require an implant. See a board certified plastic surgeon near you to learn more.

Dear Warmhearted

Thank you for your question. It sounds like you are correct and that your breasts have bottomed out following your second breast reduction.

An exam is need to fully confirm, but it would appear that removing an ellipse of skin at the inframammary fold will improve the nipple position on your breasts. This may, or may not, benefit by reinforcement with mesh.

Attached is an example of my correction of bottoming out without having to redo the incisions around the areola

Adding volume with an implant can be done at the same time if you desire to increase your volume. A virtual consultation may help resolve this question for you.

Best of luck,
Dr. Romanelli

Thanks for your question! There is a method to tightening the lower pole of the breast and then possibly adding an implant for upper pole fullness. I would suggest seeking out an in-person opinion/consultation. Good luck!

Your photo makes it hard to determine if your nipples are high relative to your chest or high relative to the breast mound. The former is hard to fix without 'chopping up your breasts' and producing a scar that extend ABOVE your nipples. The latter is a simple removal of skin (and tissue) below the breasts, without necessitating new scars or involving the periareolar or vertical scars you already have. Implants can be placed via a small inframammary incision, where you already have a scar, and will help give you upper pole fullness and better nipple position relative to the breast mound.