Going through nipple for wide set breasts? (Yes, of course I will be going for in person consultations!) (Photo)

Question

Hi- I recently posted a Q with 3 pix of my breasts. I was wondering just GENERALLY what the docs thought about sizing and shape that I can achieve based on what I have to work with. One of the docs said, since my breast/nipple are further apart, that going through the nipple would be best so they can make it closer together. That would be my goal. Natural cleavage and bigger/closer together breasts. Pic below again. Can this be achieved by going through the armpit or breast fold too? Ty!

Gerald Minniti, MD, FACS · Answer

I'm sorry that we all look like experts and we know what we are talking about, but unfortunately it's not true. This is the argument I've had with the authorities who run this website for over 15 years. Realself may have started out with the mission of helping the patient, but that quickly morphed into a site that takes money from any doc who still has a medical license and letting them answer important questions from people looking for guidance. First, your anatomy does not preclude you from having an excellent result from breast augmentation. Second, the surgeon's statement you quoted about periareolar incisions having any benefit over any other incision for whatever reason is false. Third, as I've mentioned to you prior, periareolar incisions put you at highest risk for implant contamination and capsular contracture. I'll say it again, and it's all in the scientific literature: inframammary incision, subpectoral placement, antibiotic and antiseptic wash out, funnel delivery of the implants. Immediate post operative range of motion stretching.

Brian K. Reedy, MD · Answer

Thanks for your question! I can't give you a good idea on recommendations without measurements or goal/wish looks, size, photos, etc. However, I would probably recommend something in a full or moderate profile of a moderate size (since you appear petite). I would also do an inframammary incision and I think that will hide nicely in your fold. Good luck!

Carlos Marciales, MD · Answer

Hello, thank you for asking, placing the implants through the areola does not make the nipples closer, the only way to make the nipples and areolas closer is by cutting and removing skin and bringing them closer, which would leave a scar on the entire areola, I I recommend that you place the implants through the armpit or through the breast fold, they will look very good, your areolas are at a normal distance from what can be seen in the photos, the distance will not increase, it will be the same as now.

Leila Kasrai, MD, FRCSC · Answer

Generally speaking, the implants need to be centred behind the nipples regardless of whether they are placed via the periareolar, inframammary fold, or other. If they aren’t, your nipples may end up pointing off to the side and look odd. While implants may increase your cleavage, they can only do so much. It would be best to speak with your surgeon to find out how much cleavage you can expect.

Matthew S. Kilgo, MD · Answer

Hi. In general, the ability to create cleavage with breast augmentation is dependent on the existing distance between the breasts. The access incision ( infra mammary, peri areolar or axillary) is less important. The medial border of the breast should be preserved when placing the implant to avoid symmastia. Cleavage can be enhanced by the addition of fat grafting to the procedure. I hope this helps.

Gary M. Horndeski, MD · Answer

Going through the areola to place implants allows the surgeon to reposition the nipple-areola complex to achieve better symmetry and move them closer together. I do not recommend going through transaxillary (armpit).

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Robert M. Tornambe, MD · Answer

I appreciate your concern, because size does matter when seeking a natural looking result in breast augmentation. I ask my patients to bring in photos of breasts the size they desire, because there can otherwise be confusion because B or C cup size can vary greatly by bra manufactures! I also utilize the implant in the bra technique, with several different implant sizes with a tighter fitting T-shirt to get an idea of what you will look like.
It appears from your photos that you may be slightly a symmetrical, the left breast a bit smaller than the right? I believe inframammary incision would be your best option, allowing release of your chest muscle so the implants can be placed under, closer to the midline to make your nipples look less far apart and provide better cleavage. Round smooth moderate plus silicone implants sized between 250 cc and 350 cc under the muscle should allow you to achieve the result you desire. Slightly different sized implants may be needed to achieve better symmetry if your asymmetry is prominent on physical exam, as photos can be misleading. Come see me for another board certified plastic surgeon in our area to explore the best options for you.. Good luck!

Ram Kalus, MD, FACS · Answer

You appear to have pretty and normal breasts that make you an excellent candidate for breast augmentation. Select your plastic surgeon based on his or her Before snd After gallery, patient reviews, and your overall gut impression after your consultation. After a thorough conversation with your surgeon including you sharing your “likes”, you ultimately have to trust your surgeon. Best of luck to you.

Connie Hiers, MD, FACS · Answer

You could have good results with the incision under the breasts or around the lower areola. I do not use the axillary incision because of increased risks and difficulty reusing the incision.

Karl William Schwarz, MD · Answer

The location of the incision to place an implant does not change the spacing of your breast. We cannot move the breasts from side to side, but it actually looks as if you have some good cleavage albeit your left breast is a little bit more lateral to the right breast.

I would place an implant through an infra-mammary incision as this incision location has the lowest rate of infection, bleeding and capsular contracture after surgery.

I would make sure the pocket is carefully designed so it can maximize your cleavage to make your breasts look as close as they can. I would advise against making an incision in the armpit, or in the breast, as both of these have higher risks of complication and don't have any effect on how you will ultimately look as that is based on the pocket design rather than the location of the incision.

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