Why are my nipples not centered within my implant? How would this be corrected? (photos)

Your nipple position before implants was fairly far to the side, which is normal, but the implants expanded the skin making them appear even farther to the side. If the implants were centered behind the nipples, they would be half in your armpits and several inches apart. You may need implants that are less wide as well, but what you have is not a complication.

Thank you for sharing your question and photographs and I am sorry that you are going through this.  Unfortunately your surgeon chose implants too wide for your natural breast dimensions and this has prevented them from sitting centered behind your nipple and areola.  Unfortunately the best correction is to remove the implants, heal, and then return to place more size-appropriate devices.  Hope this helps.

Based on all the photos provided-your nipples are positioned more laterally-which should have been discussed with you pre-opreraively. I would recommend staged approach. Removal of these large implants, giving it time to heal and once healed- Re-Augmentation with smaller, cohesive implants.

Dear royalltee,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Are not in a terrible position, look at your preop pictures, the way your body developed your nipples are far lateral towards the outside of your chest, so this was going to happen to some extent regardless of implant chosen or surgeon performing procedure. Should have been a conversation before surgery, at this point, downsizing will help, for sure the LEFT is not going to be fixed by downsizing along, imagine where the implant would need to be in order your your nipple to be centered, it would be hanging more than halfway off your chestimpossible. 

Thank you for your pictures and questions. First of all, let me say that I am so sorry this is happening to you. This has nothing to do with any complications that are occurring. This is all a result of poor surgeon selection and even poorer surgical planning from someone who does not understand breast augmentation surgery. You started out with a tough anatomical problem. You had very wide sternal spacing with a wide cleavage gap. Rather than have a conversation with you on how that will limit the results that can achieved and planning accordingly for a reasonable result within the limitations of your anatomy, your surgeon chose to take an implant that does not fit your breast dimensions at all and push it medially to create cleavage with absolutely no respect to the nipple position in relation to the breast mound. At this point, I am going to assume that you chose a surgeon who is not board-certified by the American Board of Plastic Surgery. Your best bet is to go see a surgeon who is and take out these implants and let things heal and start from scratch again after things heal. This is going to be hard to repair and may be better to start over. Once again, sorry this happened.Best of luck!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

If your BA was a submuscular technique, it is possible that the pectoral muscle attachments to the sternum were released in order to maximize the size of the implants. The result is that the NAC will displace laterally.  This is difficult to correct even if smaller implants are replaced. 

Dear royaltee,Thank yo for your question.  It is unfortunate that you did not achieve the results you wanted.  From your pre-op photo you are very thin and your breast are wide set and your nipple/areolar complexes are laterally oriented.  Their position on the chest wall can not be altered.  Your post-op photos indicate that your implants are bottomed-out and too large for your frame.  I would recommend the following:  A staged approach with removal of the implants at the 1st stage, replacement no earlier than 9 months later using a highly cohesive implant and possibly ADM (acellural dermalmatrix) to support the lower and lateral poles of the implant.  Hope this helps & good luck.James Sheridan, MD

your concerns are understandable. The problem originates with your existing nipple location which is far more to the outside than typical. That is how you developed. Your surgeon may have minimized your concerns by discussing this up front and planning for a smaller implant.The fix is surgical and requires moving your nipples or downsizing the implants a great deal. Or both. You will have less cleavage. Good luck  

I am sorry to hear about your concerns after breast augmentation surgery. Based on your photographs and description of concerns, you are dealing with a breast implant malposition problem. In short, your breast implants are positioned too low on your chest wall ("bottoming out") and are too close to the midline (medial breast implant malposition).  Because of the improper position of the breast implants, your nipple/areola complexes are off centered on each breast mound. More specifically, the nipple areola complexes are laterally positioned on each breast, as opposed to being better centered on each mound.  Consistent with the breast implant malposition problem you are experiencing significant breast implant rippling along the cleavage areas.

Generally, signs of breast implant bottoming out include: 
1. Breast implant "sits" too low on the chest wall.
2.  Excessive palpability or visibility of the breast implant along the lower breast pole.
3.  Nipple/areola complex seems to be sitting relatively high, because the breast implants have settled too low. 
4. Discomfort along the lower breast pole (secondary to pressure from the underlying implant).
5. Relative paucity of upper pole breast implant volume compared to lower pole volume.
6. Increased visibility of a infra mammary fold scar (higher on the breast mound).

I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). Sometimes, depending mainly on the patient's history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh.   I also use the acellular dermal matrix to provide more coverage in the cleavage area to correct significant breast implant rippling/visibility/palpability.

This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes and visibility of the inframmammary fold scars should improve with this operation.

There are several important "factors" involved in this type of revisionary breast surgery. Most important (in my opinion): plastic surgeon experience level.   In other words, experience level and technical expertise play the biggest role when it comes to successful  outcomes with this type of revisionary breast surgery.   Careful attention to postoperative activity limitations as well as use of appropriate postoperative support of dressing/garments are also important.
 I hope this helps.