How to Fix Bottomed Out Breast Lift with out Implants?

I had a breast lift (no implants) 3+ months ago. I now have very high nipples. I also have oval nipples apparently from the weight at the bottom of the breast. I was hoping to avoid implants, any options for me to get more normal proportions? I would even consider some reduction. Sternal notch to nipple 18cm, nipple to mid line 11cm, nipple to infra-mammary crease 8.5cm (straight line, not following the curved contour),breast base 13cm right/15 cm left, areolar diameter 5cm.

Doctor Answers 9

Bottomed out breast lift.

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A breast lift can raise a nipple and lift the skin, but it can be hard to successfully reposition the breast tissue..  Unless the surgeon uses a technique aimed at addressing the absence of beast tissue above the nipple, the heavy breast tissue below the nipple will bottom out, pushing the nipple further upward. The best way to treat this is by removing extra skin and even breast tissue at the level of the breast fold.  This allows for correction of the asymmetry as well, since the left side looks larger and more bottomed out. The breast will also have a more aesthetically pleasing appearance since  the nipples will be positioned more centrally on the breast mound. The breast should be allowed to "settle" prior to any additional procedures.  Good Luck

Short Hills Plastic Surgeon
4.8 out of 5 stars 19 reviews

You look like a vertical lift was done

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For only 3 months postop you have quite a poor looking result I am sorry to say.  The nipples are too high (star gazing) and there is too much baggy skin in the lower pole of the breast.  This is not "bottoming out" as that usually is a term used for implants that are too low but you are very bottom heavy because you have too much lowe pole skin (like a hammock hung too loosely between two trees). 

To improve this look, you need another surgery and this time if you haven't had one yet, you need an incision in the crease to take out some of the excess lower pole skin and de-rotate the nipple areola complex.

An implant would not fix the lower pole problem you have and would only give you more upper pole fullness so a revision can be done without an implant.

These are just my opinions and impressions based on my experience and your photos and do not constitute a consultation.

How to fix breasts after breast lift?

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The distance from the nipple/areola to the inframammary crease is very long and thus the bottom of the breast looks "bottomed out", though this is different than "bottoming out" where implants have dropped down too far.  Although on occasion a properly lifted breast can have its lower pole stretch excessively over time and require a re-tightening, this does not appear to be your case, and of course you are only 3+months out.  It does appear as if you have had a vertical lift, and this has not properly tightened the lower pole of your breast and reduced the overhang.  Without measuring where your inframammary crease it, I cannot tell for sure if your nipples were placed too high (for that is in relation to the fold), or whether they just look high because of the long areola-to-fold distance.  In any event, the best treatment is to have an excision of all that excess skin in the lower pole with a scar lying in the fold, thus tightening and lifting your breast and reducing that overly long distance from nipple to fold.

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Fixing bottomed out breast after lift.

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The only way I know of lowering the nipple if by removing skin at the inframammary fold.  When done appropriately this will lower the nipple and improve the appearance of your breasts.

Fixing Bottoming out after breast lift

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Usually you need to make the breast smaller so that there is less gravity effect to bottom outthe breast.  Implants do not fix bottoming out.  The other option is to re-do the breast lift so that the nipple is moved down but there is a chance that this can happen again!

Breast Lift Revision Options?

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Thank you for the question and pictures.

I think you will benefit greatly from revisionary breast surgery. I would suggest excision of a significant amount of redundant skin along the lower poles of the breasts.  This  excision will “tighten up” the breast skin envelope and improve the contour of the breasts.  You will find that the position of the nipple/areola on the breast mounds will be improved ( no longer appearing to point up).

Best wishes.

Changing nipple heights

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I do not think that your nipple heights are too high. The problem is with the lower poles of the breasts where insufficient tissue was resected or your tissues did not tighten up as well as expected after the procedure. I would favor additional skin removal from the infra mammary crease area which would be relatively simple and should improve the aesthetic appearance of the breasts.

Nipple position

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Based on the pictures only and your measurements that you report, it may be that your nipples are a bit high.  This can be very difficult to change. An exam would be key.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

No easy answer

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Although the measurments and pictures you provided are helpful; it is still not easy to give you a straight answer. It does appear to me that the nipples are to high on the breast mound. Lowering the nipples is not as stareight forward as elevating it. You may benefit from excisiong skin from the inferior pole of the breast. That would elevate the breast tissue and centralize the nipple over the breast mound. Is this going to be permanent ? time will tell. Good luck.

Moneer Jaibaji, MD
San Diego Plastic Surgeon

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.