Breast lift and implants -Nipples too high 18 months post-op? (photo)

Question

Had breast lift and implants 18 months ago. Implants bottomed out twice and had a final revision surgery with a new surgeon 6 months ago. Am concerned about nipples being high, but not sure if it is nipple placement or am I bottoming out again? Or is everything fine? Wondering if nipples can be moved down slightly by taking extra skin out at the inframammary incision and pulling down?

Ajaya Kashyap, MD · Answer

Thank you for your query. It seems that you had a vertical scar only mastopexy. The nipples do appear be a little higher than ideal and an infra-mammary incision along with skin excision  can help. However you will have to balance the risk-benefit ratio of having another procedure on your breasts. Please discuss your options with your Plastic surgeon who can examine you  and help you with making an informed decision.

Jeffrey M. Darrow, MD · Answer

Thank you for your photographs. Your nipple position does appear to be on the high side of normal and if you are satisfied with this and no further settling occurs, you may wish to do nothing further.  There is not a good way to move the nipple/areola complex downward, so this would be a matter of elevating the level of your inframammary fold and shortening the distance between your fold and your nipples.  As you have already had at least 2 surgeries, elevating the implants and setting a new inframammary fold level would likely benefit from using an internal support sling such as an absorbable synthetic mesh or acellular dermal matrix.  These help strengthen the tissues to retain implant position.  Have a detailed discussion regarding these options with the plastic surgeon of your choice.

Daniel Barrett, MD · Answer

Dear specialkai,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jake Thayer, MD · Answer

High riding nipples after augmentation mastopexy can be a result of placing the nipples too high at the time of surgery or more likely, the implants bottoming out / descending down your chest wall with time. Often times suture or mesh is placed beneath the implant to serve as a support for the implant to prevent them from bottoming out. I feel there are multiple ways to address this issue but my preference is to tighten the capsule on the bottom (near the inframammary incision) to push the implant higher on the chest and thus lower the nipple on the breast. I also like to add resorbable mesh ("Internal bra") to this to help support the tissue while it heals and prevent the implant from descending again. Great question!

Gary M. Horndeski, MD · Answer

Yes, your nipples are slightly too high. You could can either live with this or undergo eccentric circumareola mastopexy to lower them down or a curved linear incision in the fold to pull the breast down. You would also benefit from smaller implants. You can also consider fat transfers to the upper pole of the breasts.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

It does appear your implants are bottoming out.  You may consider adding bioabsorbable mesh for more support and/or selecting smaller implants.  A revision would address the shape and correct the nipple position.  I've included a video I hope you find helpful.

Connie Hiers, MD, FACS · Answer

Your nipples are not too high, but your breasts have dropped again. No, the nipples cannot be moved downward, but the sagging tissue and implants could be lifted. You may need to go smaller to have less weight on your tissue..

Breast lift and implants -Nipples too high 18 months post-op? (photo)

Answers (7)

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