Nipple positions too close after a breast reduction. What are my options?

Question

I am nearly 1 year post op of a breast reduction and have been struggling with my nipple position and breast shape. I feel like my nipples are very high and close together, so there is not much upper pole or inner breast fullness. I often find that my nipples peak out of the top of my bra's and bathing suits. While my left nipple is 11 from the centre of my chest, my right nipple is only 9cm. I was wondering if there were any options I could take to try and get them in a more natural position?

George Bitar, MD · Answer

It is likely that this can be improved with a revision.  Often excising skin above the inframammary fold tightens the lower pole of the breast, shifting tissue higher resulting in more upper pole fullness and a more central location of the nipple.  If your areola is visible in bathing suits, sometimes the areola diameter can be reduced.  Having the nipple too far medial is more difficult to correct but often small adjustments can be made that can improve the appearance.  I would suggest either revisiting your surgeon to discuss this matter or considering consultation with another Board Certified Plastic Surgeon with significant experience with revision surgery.  Best of luck!

Kenneth Hughes, MD · Answer

The skin envelope can probably be reoriented to lateralize the areolae and improve symmetry.Kenneth Hughes, MD
Los Angeles, CA

Raymond Goh, MBBS (Hons), FRACS (Plast) · Answer

Hi tashanon.
I am sorry to hear of your disappointment post breast reduction.
Although breast reduction is primarily a procedure of functional improvement (by reducing the weight and size of the breasts and therefore reducing neck/shoulder/back pain), the cosmetic outcome is just as important to optimise.
A high nipple is difficult (almost impossible) to lower. Having said that, the cause of an optically high nipple may be "bottoming out" of the lower pole tissue. That is, the tissue under the nipple has dropped. One can do a wedge-type reduction of the tissue here, in order to place the whole breast mound higher on the chest. Although this manoeuvre does not actually pull the nipple lower, it looks more central relative to the whole breast. 
In terms of  medialization of your nipples, its difficult to give suggestions on this without seeing a photograph. Please communicate with your plastic surgeon your concerns. I am sure he or she will try to improve things for you if possible.
All the very best.
Dr Ray Goh

Adrian Sjarif, MD · Answer

Hi and thanks for sharing,
Nipple areola malposition following breast reduction can usually be rectified with revisionary surgery - with that said however, it is usually easier to elevate a nipple that is too low on the breast rather than move a nipple down that is sitting too high.
Part of the problem is usually that the distance between the bottom of the areola and the inferior breast fold is relatively long and the position of the nipple can be improved by reducing this distance - usually by removing a wedge of skin and tissue from the inframammary fold and then stitching the new fold down hard onto the chest wall - the result will be a nipple that sits in a better position on the breast mound.
I'd suggest going back to your PS to discuss your concerns so that you can plan together the best step going forward.
Best of luck

Tom J. Pousti, MD · Answer

I'm sorry to hear about your concerns after breast reduction surgery; it would be helpful, for more accurate assessment and advice, to post frontal and side view breast photographs, with your arms by your side. Based on your description, it sounds like you may benefit from revisionary breast reduction surgery. Sometimes, removal of additional skin along the lower breast poles will help improve position of the nipple/areola complexes on the breast mounds.  Adjustment of the nipple/areola complexes may also help improve your overall symmetry. Best to communicate your concerns and goals directly with your plastic surgeon in front of a full-length mirror. It is very likely that working together you will come up with a good plan to achieve an outcome that you are happier with.

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