I'm not happy with my NAC being so low, and the lower pole. What things should I be asking about a revision? (Photos)

Question

I had bilateral nipple sparing mastectomy in December 2024. It was supposed to be direct to implant, but my skin was not in good enough condition to do that. Implants were placed Jan 2025. I have always had very little lower pole. It was a concern going into this. I’m not happy with my NAC being so low. Also not happy with the little change in lower pole. I thought my skin was going to stretch and that would be improved. To top these issues, the left breast is contractured due to bleeding that occurred after my drains were pulled. That led to the left breast being massive and swollen at first. I see my surgeon next week so I am wanting to know what sort of options I should be thinking about.

Gary M. Horndeski, MD · Answer

Your implants are too large and your breasts are virtually touching in the midline.  I recommend smaller implants and this will take care of some of the upper pole fullness.  You also need the nipple-areola complexed elevated as well.  Another alternative is to release the inframammary folds.  However, this can results in bottoming out.

Best Wishes.

Gary Horndeski, M.D.

Adam Tattelbaum, MD · Answer

Certainly worth discussing the possibility of a lift with your PS, but it may be worth waiting and agressively massaging the implants downwards till you hit a year. CC may proclude this.  Lift may be possible but requires great consideration of blood supply to the nipples because of your sub q mastectomy.  I could only guide you further with an in person exam , but I hope this helps.

Ram Kalus, MD, FACS · Answer

Thank you for you question and sorry to learn of your disappointment. A correction is indeed possible. Breast aesthetics are all about proportions. We intuitively know what a pretty breast looks like, and the easiest solution in your case is to lower your inframammary fold and therefore visually correct the NAC position in relation to the breast mound. Downsizing can also help.  This will inevitably bring your scars out of the fold and in to the lower pole, but in my experience, patients are far more willing to accept a potentially visible scar with a pretty and well balanced breast than an unattractive one.

Discuss your concerns with your plastic surgeon. If you are not confident her or she can achieve your goals, please consult with an experienced board certified plastic surgeon who specializes in revision breast reconstruction. Best of luck to you.

I'm not happy with my NAC being so low, and the lower pole. What things should I be asking about a revision? (Photos)

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I'm not happy with my NAC being so low, and the lower pole. What things should I be asking about a revision? (Photos)

Answers (3)

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Recommended reading

Everything you need to know about Breast Reconstruction Revision

Our mission is to create a world where every investment in modern beauty is Worth It.