Will implant alone help with sagging nipples? I have nursed three kids and my breast are not saggy but my nipples are.

Question

I’m 32, done having kids. My nipples fold over and look saggy. I want implants and want to increase my size 2 cups. Is there a separate procedure I will need to have to fix my nipples or will the implants push them out enough that they will appear not as saggy?

Joe Gryskiewicz, MD, FACS · Answer

To answer your question, " Will implants fix my sagging nipples"?   Implants will only help pop up nipple placement to a certain degree.  There are many factors that need to be considered before concluding that in your specific situation only implants would help. Generally, if your nipples are at the bottom of your breasts, or pointing down, implants will not help this situation. You will need if not a lift, a second procedure to fix your nipple placement.

Daniel Barrett, MD · Answer

Hi Megan3043,
  
Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
  
Implant profile is one of the important considerations to make. Many patients wrongly assume that the higher the profile the better. The truth is, the more profile (or projection/height) and implant has, the narrower its base has to become. This is associated with several problematic consequences. 
  
The first issue is that the patient loses width and therefore cleavage of the breast. The second is the breast becomes more narrow and pendulous, often falling lateral and onto the side of the chest, and third, high profile implants have a higher risk of bottoming out because they exert more pressure on the inframammary fold than moderate profile implants. 
  
High profile implants do have a role in symmastia repair (when I need to narrow the base width) but otherwise I try to avoid them.
  
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements. 
  
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match. 
  
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
  
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
  
Daniel Barrett, MD, MHA, MS
  
Certified, American Board of Plastic Surgery
  
Member, American Society of Plastic Surgery
  
Member, American Society of Aesthetic Plastic Surgery

Paul F. Vanek Jr, MD · Answer

Saggy nipples can make you feel less sexy and vivacious. Sounds like you have a specific augmentation goal in mind. I'll help with your specific implant selection when we do custom sizing in the office setting. Your decision making about the augmentation includes the desire to have your nipples rejuvenated at the same time. A papuloplasty is a plastic surgical procedure that happens in the office or at the time of the augmentation surgery. It does not  increase your recovery time to change the shape or perkiness of the nipple. If you've already had your augmentation, then I can perform a papuloplasty on one or both sides in the office under local anesthesia.  If it is too big it can be reduced in projection or diameter, to make it look less conspicuous. The scars are imperceptible. If the nipple is inverted, it can be everted to look like a normal projected papule.

Edwin C. Pound, III, MD · Answer

Unfortunately, you did not include a picture for evaluation.  Nipples that are too long or "fold over" as you described can be reduced in length if necessary.  This could be done under local anesthesia in an office setting.  I don't think that simply adding implants will solve the problem long-term.  I suggest that you visit a board-certified plastic surgeon who can evaluate you in person and review your options with you.

Jon Paul Trevisani, MD, FACS · Answer

Hello and thank you for your question! Placing an implant alone will NOT lift your breasts. Your nipple position will still be low and the breasts will still have some ptosis (drooping). A breast lift will certainly lift your breasts to a desirable position. However, as you may know, a breast lift will require more incisions and thus resulting in more scarring. It is often times challenging inserting a larger implant during a breast lift surgery because of the risks associated with this. Such risks include: a lot of pressure on the incisions with a larger implant can cause poor wound healing, premature sagging. Often times when the procedures are separated into two step procedures, a patient is able to have larger implants. Step one would be to have the Mastopexy (Breast Lift) surgery alone. Step two would be to have the Breast Implant surgery.I would suggest seeing a board certified plastic surgeon in your area for a thorough examination and evaluation. Best of luck to you!

Harry T. Haramis, MD, FACS · Answer

After breast feeding, nipple sagging can be improved by implants. Large implants for 2 cup size increase should also help sagging breasts in general.An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations.

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive (some want smaller less droopy breasts and others want larger less droopy breasts).
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision.
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon (ABPS). Patients should discuss their concerns with their physicians in order to make an educated decision.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  It would be helpful if you could include pictures.  From your description, if your nipples are below your inframammary fold, then a breast lift with implants will be your best option.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

James Knoetgen, III, MD · Answer

Implants alone might not fully address sagging nipples, as they primarily enhance breast volume and shape. For addressing nipple sagging, a combination of procedures might be needed.
A breast lift (mastopexy) is typically recommended to reposition and tighten the skin around the nipples. This procedure can help address sagging and improve the overall appearance of the breasts.
It's best to consult with a board-certified plastic surgeon who can evaluate your specific situation and recommend the most effective approach to achieve your desired results. If you’re considering implants, discussing your concerns about nipple sagging during the consultation will help in planning the best treatment for you.

William Aiello, MD · Answer

Hi Megan3043, I'm not sure if you really mean just the nipple itself is sagging or your entire nipple/areola complex. Patients often interchange the names of these parts of their anatomy. The areola is the darker circular skin on the breast, the nipple is the part that sticks out from the areola. When your areolas are lower than your breast crease, adding implants without removing excess skin will make them sag even more. Breast implants simply add volume. They do not lift or reposition your breasts. If it is truly only the actual nipple that is sagging, not the entire areola complex, a simpler nipple reduction could be done. 
It's time to meet with a board certified surgeon. You need an in person exam to assess the degree of laxity in your skin and go over your goals. Your surgeon should work with you to understand what is a realistic outcome and go from there. Make sure you meet with a board certified plastic surgeon who specializes in the procedures you need and can show you many outcomes they've achieved that are favorable. Good luck!

Will implant alone help with sagging nipples? I have nursed three kids and my breast are not saggy but my nipples are.

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