Want Implants but I have Inverted Nipples and the Areolas are Asymmetrical in Size, Options?

Thank you for the question.

It would be much better to give you  precise advice after direct examination. However, I will try to address all 3 of your concerns in a generalized fashion:

1. In regards to breast implant size: communication with your plastic surgeon will be critical to help you achieve  your goals with the breast augmentation procedure.

In my practice I find the use of goal pictures to be very helpful.     I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful. 
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
 


I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. 


2. Inverted nipples can cause functional problems for women and emotional concerns. An inverted nipple can look flat or a slit like depression or hole at the normal nipple location. There are different degrees of inverted nipples possible. Whether a patient is a candidate for correction of inverted nipples  depends on the  extent of the problem.

Usually correction of the inverted nipples involve division  of the lactiferous (milk ducts). The risks  of the procedure include potential loss of sensation, inability to breast-feed, recurrence of the asymmetry and the potential need for further surgery.

My advice to patients go something like this...  If the nipple is permanently inverted and does not evert  with stimulation, then it is a useless nipple  when it comes to sensitivity and/or breast-feeding. In these  cases correction of inversion is indicated (because the potential gains outweigh the risks outlined above).  On the other hand, if the nipple does evert  spontaneously with  or without stimulation,  then I am more reluctant to perform the procedure given that the risks may outweigh the potential benefits.  At that point, the decision is the patient's to make after careful consideration.

You should also be aware,  that on occasion, nipples do evert  after breast augmentation surgery ( if not, nipple inversion surgery can be done at a later date under local anesthesia if necessary). 

3. Areola reduction surgery may be very effective in reducing the size of the areola. However, this procedure may be associated with unsatisfactory results. For example, you may find that the breast profile is flattened after this procedure.

It is also important to know that the areola scar will always be noticeable (some more than others). This may be because the scar heals with too much or too little pigment or because the scar is raised. You should also be aware, that areola reduction surgery does carry other risks such as spreading of the areola, asymmetry, shape irregularity etc. in order to avoid disappointment, it behooves you to be aware of the worse case scenario and, armed with that  information decide whether to proceed with the procedure, or not.

I hope this helps.

Best wishes.

Your question is difficult to answer without undergoing a thorough examination as there are many variables to sort out in order to achieve a symmetrical outcome. Regarding the inverted nipple: first step is to determine if this is a long standing inverted nipple with foreshortened ducts or a recent onset.  Breast masses below the nipple can lead to a unilateral inverted nipple, so you will want to sort this out first. Secondly, there are a variety of reliable techniques for release of the inverted nipple, but functionality of the nipple is often lost so breast feeding will likely be limited.  Techniques for areola reduction are well described as well and often used to create symmetry.  If you have a tuberous breast or restrictive breast, creating perfect symmetry may be more challenging and may require a few steps spaced over a period of time. Best of luck