High riding areola - what procedure would improve this situation? Would implants help? (Photo)

Implants will add volume and will need to be placed higher on your chest wall. This may make the breasts fuller on top. However, you need a revision of the inferior incisions, in such a manner, that it will pull the nipple-areola complex down lower.

Best Wishes,

Gary Horndeski, M.D.

Correcting NAC that are too high is much more challenging than the alternative (too low). For this reason, most will err on the side of "lower" when planning a mastopexy/lift.

To actually lower the NAC will require a suboptimal scar above the areola. The alternative is to revise the lower pole scar removing tissue and decreasing the nipple to fold distance. This creates the illusion of lowering the NAC by establishing better balance.

With regards to your specific question, implants won't necessarily play a role in correcting the issues of concern. Suture reactions are unpredictable but anecdotally speaking, monofilaments are better tolerated than braided suture.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Dear Friendly468768,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

That surgeon did you a disservice with the periareolar lift; he took too much skin from above the areola, permanently fixing the distance from areolar edge to clavicle. That is why the revision to a full mastopexy didn't help. The only way to bring the nipple areolar complex down is with a procedure that will leave a vertical scar above the newly repositioned nipple areolar complex. Although far from desirable, it may be better than your situation now.

From the photos submitted you will need a revision to your lift for improvement in the shape. Mesh may be recommended in your case to give support to the tissues. As far as the suture material is concerned, this is something you can discuss in more detail with your surgeon. I've included a video that I hope you find helpful.

Just based on your photos and not measurements, I would say that your nipples are probably in the correct position, but your breasts have bottomed out and are sagging too low. Your breasts can be relifted without moving your nipples. Implants might make this worse unless placed behind the muscle. Find out what sutures were used, this is noted on the operative note, and avoid those.

High riding nipples is a complex and difficult problem to correct.
It is important to know which pedicle the nipple was maintained on,as correction will involve elevating the lower tissue into the upper pole of the breast .Mesh support would also be of benefit .
Placing an implant could make the situation worse

It’s difficult to lower the nipple areola complex once it’s been placed in a high position. attempting to lower the nipple position is inherently difficult. The alternative is lifting the breast by removing more skin on the inferior half of the breast.
It looks like you may have had some bacterial contamination of the suture material. This sometimes happens and it’s probably not so much related to what suture material was used. That said there are potential alternative suture materials that can be used. most absorbable, suture material are made of similar substances.
Your situation is not easy to correct, but the overall appearance of your breast can be corrected and improved with tightening up the skin envelope, but this will not lower the areola.
Follow up with your provider and discuss your concerns with him or her. Your surgeon should know that you’re unhappy with the outcome so they can make adjustments in the future when they do these procedures.
I wish I could be a little more optimistic in my response. You may want to consider getting some in person second opinion consultations. For second opinion consultations, I suggest patients come prepared of bringing with them complete sets of before, and after pictures and copies of your previous operative reports. You should all be available in your providers office.
Best,
Mats Hagstrom, MD