5 years post op -r eally bad scarring and extremely high upwards pointing nipples. How can I fix my botched breast lift? PhotosP

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).

I think you would benefit from a revision mastopexy. I think benefit is two-fold. Firstly, the scars will be re-done so there is a high likelihood that the scars will be improved assuming you do not have a healing problem, which is not-uncommon in breast lift/reduction. Secondly, the breast shape and proportion will be better by removing tissue from the lower aspect of the breast improving shape and lift. I would not hesitate to recommend revision mastopexy . . . Thanks and I hope this helps!

Hello, I’m sorry to hear about your disappointing experience. Upon evaluating your photos, I noticed that you have hypertrophic scars on your breasts and glandular ptosis.First of all, I want to assure you that your condition is manageable. Based on my professional experience, I believe that a breast lift combined with a small implant can provide excellent results.It is crucial to take proper precautions immediately after surgery to minimize the risk of developing hypertrophic scars.

The problem in your case is not the nipple position; it seems quite normal according to your arm, chest wall and abdomen ratios. You have a severe bottoming out deformity in which the nipples stay in position and breast tissue goes down. It can be corrected with a pushup lift with your own Brest tissue; with keeping your breast volume and shaping your own tissue; creating a good curve and upper pole fullness. All cars can be revised at the same time.

Hi, thanks for your question. You have a few issues (based on the photos) that could be improved - the feeling that the nipple is too high, stretched scars, and a long nipple to inframammary fold distance. I would recommend shortening the nipple-IMF distance and revision of the scars, which would provide better overall balance. Fat grafting to the upper pole would help to mask the appearance of the nipples being too high. Lowering the nipples can be done, but it would require a scar above the nipple areola complex which may be visible in a bra / swimwear. If you are happy to accept that, then lowering the nipples is very feasible. Consult a surgeon who has a specialist in aesthetic breast surgery.

Dear Neat646403,


breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.
Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.
While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.
If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.


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

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for your photo. Option #1: To reposition your nipple/areola lower would leave a scar above your areola. The length of that scar would depend upon how far down you want to move your nipple/areola. During this lowering of your nipple/areola, revisions of the other incision lines could be done to improve them. Camouflaging the incision line above the top of your areola may be an issue. Option #2: remove skin crescent from the lower portion of your breast, to shorten the distance from your nipple down to your inframammary fold so that it appears that your nipple/areola is positioned over the center portion of your breast as opposed to the upper portion of your breast. Your other incision lines could be revised at the same time with this approach as well. This would not create any new incision lines above the top of your areola. I would favor option #2 as it is a simpler procedure and does not add any new incision lines. Should your breasts settle again, this is easy to repeat. Best wishes.

Hello and thank you for providing photos. It appears that you have pseudo ptosis, with nipple areolar complexes at too high of a location on your breast architecture. You also have widened scarring that could potentially be revised. I recommend that you consult with multiple board-certified plastic surgeons and move forward with the surgeon of your choice offering a revisionary mastopexy.

The technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery.

Best Wishes,

Gary Horndeski, M.D.