6 months post op and nipples are too high. Do I have procedure options that will not require implant exchange? (photos)

Question

I am 6 months post op and I think my implants are not settling properly. I think there isn’t enough volume at the top of my breasts. I have 480cc uhp textured implants. For the past couple of months I have also noticed that no matter which bra I wear, my nipples stick out at the top of the bra. If I would want to fix this by getting another surgery, does this mean that I would have to get different implants again or are there any other methods that don’t require the implants to be changed?

Stefan Mark Szczerba, MD · Answer

Your nipples are probably not too high... instead your implants are too low and thereby causing the lower pole of the breast to "bottom out".   This can happen if your surgeon uses implants that too big for your frame.  Another cause is the surgeon takes the risk and inserts the implant through an incision that is too low giving the implant room to descend.  Repair requires tightening the pocket (called plication) and I personally use mesh (Galatea) to support malpositioned implants.  Best Wishes!

Shlomo Widder, MD · Answer

Dear Anna,
   Thanks for posting your pictures and sorry for your problem. From observing your pictures you appear to have developed a 'Bottoming out' condition, which means that your crease is too low, creating the false impression of high nipples. The reason for for that condition could be superior pocket capsule contracture that pushed the implants downward . It is easy to diagnose on physical exam. Another possibility is that the surgeon lowered crease excessively . In any even, you do not have to change the implants, but rather have inferior capsulorrhaphy (internal bra) which will raise the breasts creases with the implants and correct the high position of the nipples as well as give you more fullness of the upper poles. In case that you have superior pocket capsule contracture, you will need a superior capsulotomy (scar release) to enable the implants to move upwards. 
    Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.
                  Best of luck,
                                     Dr Widder
                               widderplasticsurgery.com

Daniel Barrett, MD · Answer

Dear annars226,
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

Zoran Potparic, MD · Answer

Properly placed implants would bring nipples  on the top of the breast mount. It appears that bringing lower breast crease (imframammary fold) up would correct currently high riding nipples. Good luck.

Connie Hiers, MD, FACS · Answer

Your nipples are not too high, but your breasts have bottomed out from the weight of the implants. You need to go with smaller implants, perhaps an internal bra with mesh for support, and lift your inferior pocket back to its normal position.

Douglas Taranow, DO, FACOS · Answer

Annars,
Your breast implants have "bottomed out" causing your nipples to be too high and pointing upward.  The fix is a revision with plication (suturing of the capsule at the bottom of the breast) with or without ADM (Acellular dermal matrix...tissue used as a sling or support at the bottom of the breast to inhibit reoccurrence).  
The cause:
The patients own tissue not being strong enough to support the implants
The implants being too large and heavy
Surgeon error making the pocket too low. 
Best wishes,
Dr. Taranow

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