I Have an Inverted Nipple, Large Areolas, and Sagging Breasts from Pregnancy, What are My Options? (photo)

It's not unusual for women to note significant changes in their breasts following pregnancy. Your pictures suggest several areas of concern. Not only do you have breast hypoplasia, but you also have bilateral breast sag. In addition, your left breast is larger and has more sag than your right breast. It's also important to note that you have enlarged areolas and an inverted left nipple.Correction of these problems will require breast augmentation with larger fill volumes on the right side. Breast lift surgery will also be required. This procedure will also address your enlarged areolas. A secondary procedure at a later date can be easily performed to correct your inverted nipple.It's important to consult a board certified plastic surgeon who has experience with these procedures. Several issues require resolution before proceeding with surgery. These include the size and style of breast implants. The type of lift and the position of the implant relative to the chest muscles. Once you have a comfort level with these issues, it's reasonable to proceed with surgical intervention.Patients are able to resume most of their normal activities one week after surgery. Heavy lifting should be avoided for at least 6 weeks following surgery. Patients should avoid air travel in the immediate post-operative period unless covered with Lovenox whenever possible.

This is what I do to maximize lift with a breast implant alone:- use silicone cohesive gel implants. The more cohesive the better. I am not sure if these are available yet in the US, but the Allergan Inspira Truform 2 implants are ideal- use high profile implants. The more projection you have, the more lift you will get- have the implants placed in the submammary pocket (under the breast itself). You should have a pinch thickness at the top of your breast of at least 2 cmHowever, a lift may be better able to achieve your expectations. Areola reduction can also be performed .

Your options are for a breast lift only, or for a breast lift with implants if you want to be bigger.  Schedule a consultation with a plastic surgeon in your area to ge the details for a specific recovery regimen.

hi there-

It is first important to be sure you will have no further children, as another pregnancy will probably adversely affect any surgical outcome achieved.

Secondly, please be aware that nipple inversion, when new, can be a sign of a problem that you should notify your family doctor and/or gynecologist about.

Assuming that you are healthy and there are no concerns about your breast health, your options are to have your breasts lifted, or to have them lifted in conjunction with placement of an implant.

From your description of your goals, I think you would probably be best off with lift/implant, but the best advice I could give you is to spend your time and energy researching and locating a GREAT SURGEON, and THEN worry about the what and the why.

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I would recommend a breast lift together with modest size breast implants. I would emphasize the lift over the size. These two procedures work in sort of opposite directions. The larger you want your breast, the less tight it can be made. Because you want your areolas to be smaller, and I agree with you on that, more skin will need to be removed in order for them to look good. With more skin being removed there is less room for the implant. Basically I would recommend going for the "higher, tighter, perkier breast" rather than the "larger fuller breast". I still think that an implant of about 250-300cc would work which at the end of the day would increase your cup size by about 1 size

An augmentation with mastopexy will improve your volume, lift your breast, and reduce the areolar size.  Your left nipple appears to be only partially inverted as it is protruding in one of the pictures.  This is common and will sometimes improve after implant placement.  I would recommend that you see what happens with the nipple inversion after the surgery, then correct it at a second procedure if it is still inverted.

From your photos and goals, you are a great candidate for a breast lift with areolar reduction. You stated that you want fuller breasts and your photos show that you have lost some volume in the upper poles of your breasts. This is difficult to restore without an implant. The implants can be placed at the same time or at a second stage after your breast lift. If you are having implants placed, the concern for contamination with bacteria from your nipple would be another reason to address the inverted nipple at a separate procedure.

A breast lift with augmentation would address the extra skin, enlarged areolas, and increase fullness in your breasts.  Inverted nipples can be corrected, however I would not recommend surgery for the nipple at the same time since there is a risk of loss of blood supply to the nipple with all that surgery (and losing your nipple).  Placing an implant and doing a lift (or mastopexy) may even help push the inverted nipple out, since it looks like it comes out easily on it's own in your photos.   Having help at home for at least a week or two is important so that you can avoid a lot of lifting.   There is no specific contraindication to flying after surgery, but the risk of forming blood clots is higher after general anesthesia, so sitting for a long time in a car or airplane  is not advisable.

Given the goals that you stated, a breastlift or mastopexy is your best option. Whether or not to add implants depends upon how you feel when your breasts are properly fitted in a bra. If you like the volume in a well-fitted bra, implants are not necessary. A mastopexy will reduce the areolar size, improve the position of the nipples, improve breast projection (perkiness), and remove excessive skin. The recovery is fairly rapid (1-2 weeks), you can fly after a few days, and you can lift your toddler in 2-3 weeks. Also, if you wished to have an augmentation at a later date, it becomes a much more straightforward procedure when staged after a mastopexy.

Thank you for the question and pictures.

I think you are an excellent candidate for breast augmentation/mastopexy surgery. This operation should meet all of your stated goals. The operation will involve “down time” of about 1 week. You should be able to fly after a few days and hold/carrier toddler after 2-3  weeks.

Best wishes.