Why Not Lift Above the Inframammary Fold Height? (photo)

I am a modest A cup but very happy being flat chested, just not with the sag (no implants for me.) My understanding is that the nipple 'should be' nearly level with the inframammary fold. For me, despite very loose sagging breasts, this measurement means I'd only get a cm height difference. Can't nipples be lifted to the 'center' of the breast, well above the fold? This is the look I prefer. I feel as though my lack of volume/projection would stop 'upfacing nipples' from being a problem. Wrong?

Doctor Answers 9

Circumareolar Lift in Small, Droopy Breasts

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   A circumareolar lift can be performed to lift the areola and reduce some of the skin excess.  However, the circumareolar lift always flattens the breast to some extent.

Lift to the height you desire

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The ideal position of the areola is halfway between the shoulder and the elbow.  Your areolas are approximately 3 centimeters below their ideal position.  You would benefit from a new technique called The Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to reshape your breast tissue, lift them higher on the chest wall to increase upper pole fullness and more medial to increase your cleavage.  You are an excellent candidate for this new technique that does not require implants.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Why Not Lift Above the Inframammary Fold Height?

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The nipple should indeed be centered on the breast. If the bottom of the areola is below the fold, that fits a definition of ptosis to most, but it does not define what is normal or desirable. One of the issues with a lift on a small breast is the ability to have enough tissue to fashion a nice shape that will not be overwhelmed by any abnormal wound healing that may occur, so it is a little unusual to do a lift only a smaller breasts.

When you ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S.

Thank your for your question, best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

A purse string mastopexy can help

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Thank you for the question and photo.  A purse-string mastopexy can help you accomplish the results you desire.  You will still have residual laxity since your breasts are lacking volume but they will be a little less lax and the nipple/areola complex will be higher above the fold.  You may also consider fat grafting to the breast for additional volume if you wish to improve the volume of your breasts without using implants.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Full breast lift will bring the nipple higher

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Your nipple position is low and need to be higher as you noted.I would offer breast lift and fat grafting to replace the lost breast tissue. The main reason for the fat is to fill the upper pole and cleavage.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

Why Not Lift Above the Inframammary Fold Height? (photo)

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It should be possible to elevate your nipples to the correct position with a circum-areolar incision

This can be further enhanced with internal  suturing and possibly the addition of absorbable mesh

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Breast ptosis and lift

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A lift usually requires tightening up the skin envelope, elevating the nipple areola complex to a more pleasing position, and contouring the breast tissue. 1 and 2 can possibly be done for you, but 3 will be diffficult with minimal to no tissue. A small implant may help and limiting the lift to just around the areola may be the solution without adding more incision on your breast.  An exam in person is key.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Positioning of Nipples/Areola During Breast Lifting?

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Thank you for the question and pictures.

Your understanding about the position of the nipple/areola being “level” with the inframammary fold  is not entirely correct.  I think what you are referring to Is what plastic surgeons used to define breast “ptosis";  if the nipple/areola complex is below the inframammary fold patients benefit from breast lifting.

Ideally, the position of the nipple/areola should be significantly higher than the inframammary folds.  Care must be taken however to avoid raising the nipple/areola too much; even without breast implants “up facing nipples” can appear unnatural/abnormal.

I hope this helps

Elevating the nipple in mastopexy

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You are entirely right, the nipple just at the IM crease level is not high enough to look great. You just can't go so high that they are "star gazing" because you can't fix that.  When I mark a madtopexy with the patient standing preop I mark the top of the areola to be 5 cm above the lowest point of the IM crease.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.