Do I need a lift (because of nipple placement)? (Photo)

Dear Funny728880,
determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Thank you for your question. 350 could be suitable, and any larger size may cause breast sagging. However, it's important to have a consultation because choosing implant size depends on accurate measurements of your chest, including the base width of your breasts and the distance between them. Also, your height, weight, shoulder width, and hip width should be considered to maintain a balanced appearance. Regarding your concern about having upper breast fullness and more support with less drooping, you may require a breast lift to raise the breasts and position the implants behind the muscle.

Ideally, your breasts would be rounder in shape and the nipples would be centered on the breast mounds. If this appearance is your goal, then a lift would be indicated. Placing larger implants would not help this and could potentially make your current condition worse.

Your nipples are located below your breast fold therefore a lift would be recommended. Implants alone would probably not be sufficient. It would difficult to give you an opinion on whether 350 was the largest you could have gone in your first surgery without further information.

In my personal opinion, I would recommend a breast lift. Placing larger implants is not going to create a harmonious breast shape. Bigger implants also tend to just create bigger problems long term.

I must caution you that placing larger implants can stretch the breast skin, causing sagging. The implants will lower the bottom pole, and effectively raise the areola. Just keep in mind the breast will not be perky. Just larger, and lower down on the chest. A lift may be better, retaining the same implant size.

Thank you for this question. Ideally, you would like to see the areolas in a higher position on the breast mounds. This repositioning would improve the overall aesthetics of the breasts, by reducing the cone shape that the breasts have, and rounding out the mounds in the profile view. This would be true even without changing out the implants to a larger size.

The least amount of visible scaring would occur with a donut mastopexy, with the excess skin taken out primarily from above the areola. The final scar would be a round scar around the areolas. A soft permanent Gore-Tex suture would be left in place to ensure that the areolas do not enlarge over time from the pressure of the larger implants you would like to have. Alternatively, you could get a higher repositioning of the areola with a vertical, lollipop, mastopexy. The downside being that you would have a visible vertical scar on your breasts below the areola. That said, I believe a donut mastopexy will give you the lift, and breast mound shape that you desire, along with, reshaping the lower breast pocket, and an implant exchange to a larger size.

Dr. B.

Overall, your breast tissue is slightly lower than your implants. This would be termed a mild "waterfall" deformity. However, this does not look particularly unnatural based on the pictures you have submitted. It would look closer to the aesthetic "ideal" to have your nipples centered more around the implants, but I have found in my practice that this sometimes is not what the patients desire. while larger implants will lift the nipple slightly, it will not lift it to the degree that you are likely to be happy with if you perceive them as low right now. In terms of how high you could have gone with your original surgery, this is based (or should be based) on your specific tissue measurements taken prior to surgery. There would be no way to comment on this without knowing these measurements or taking the measurements yourself.

Your breasts are widely separated, low on the chest wall and your nipples are pointing outward. I recommend a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, you can replace the implants or do fat transfers to fill out the areas you dislike.

Best Wishes,

Gary Horndeski, M.D.

You definitely would need a lift. Although you could go larger than 350 I think 350 is a good size. A lift with implants can be done in one or two stages, the second stage being the placement of the implants.,it’s a tricky operation so you need to find a surgeon with a lot of experience in this particular procedure