I am noticing a discrepancy between after photos (breast enlargements) in terms of nipple alignment - why is this?

Some surgeons seem to have excellent alignment whilst others not so and I'd like to know (if possible), why that would be? Is it technique differences, lack of experience, different incision points?

Doctor Answers 5

Nipple position after breast implant surgery

Hi there Jess,

Good question and a tricky one.

If the nipples were asymmetric pre op, then they will be post op. Body asymmetry is really common, but often not noticed preop! Expansion of the breast envelope can also reveal subtle asymmetries in breast tissue or nipple position that were pre-existing.

If the nipple differences were CREATED by the surgery, it is because of an asymmetry in the post op position of the implants.

Implants should be placed in symmetric pockets. However, perfection is not always attainable.

What is happening when you see different surgeons results? Truthfully, you might just be seeing that some surgeons are more careful about the pictures they select to show on Realself than their entire body of work. You might be seeing that some surgeons are happy to show the full range of their results, and others select out only perfect pictures.

Here's a tip:  No surgeons actually gets this 100% right all the time. It's not possible, despite the impression they may try to create by being selective about their public images.

All the best,

Howard Webster

Plastic Surgeon.


Discrepancy in nipple position after breast enlargement

Hello, if you see a discrepancy the first thing to look at is the preoperative photo, because inserting implants will not usually correct pre-excising nipple asymmetry.  The other possibility is implant malposition but most surgeons will assess the breasts carefully while the person is still asleep to ensure that the implants are sitting properly.  Even if they do this, sometimes one implant will drop more than the other.

Nipple Asymmetry

Any horizontal nipple asymmetry before surgery will become greater after surgery. That is a basic tenet of breast augmentation surgery. It is also important to look at patient posture and positioning in the before and after pictures as that can affect how the nipples look.

Nipple alignment

The alignment of the nipples, after breast augmentation only, is totally predicated upon where the nipples were as far as symmetry goes before surgery. Simply placing an implant, centered on the breast mound, may appear to magnify the small difference in nipple location on the chest wall. By comparing the preoperative photograph to the postoperative photograph, one can see where the patient started from. The type of incision or different techniques shouldn't have much of a bearing on that portion of the outcome. Best of luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

Difference in aesthetic outcomes with breast augmentation surgery?

Thank you for the insightful question. As you know, careful selection of plastic surgeon will be the most important decision patients make when they decide to  undergo surgery to achieve a specific outcome. Besides appropriate training and experience, looking at before/after photographs (and  preferably talking to previous patients) can be very helpful in this selection process.



 Basically, patients should look at the overall "quality" of the outcomes achieved;  in other words, it will be important that patients see lots of examples of outcomes that they would be pleased with.  In doing so patients will be able to get an idea of each  plastic surgeon's "aesthetic sensibilities". Of course, careful evaluation of the photographs (including factors such as time out of surgery and initial anatomic starting point) will be important as patients evaluate before/after photographs.


Sometimes, any existing breast asymmetry may persist after breast augmentation surgery.  In other words, careful evaluation of the pre-operative photograph is important when  evaluating the outcome of the procedure performed. In other cases, asymmetry may be related to factors such as precision of the operation performed;  in these cases, the outcome is determined by surgeons skill level.


 Well experienced plastic surgeon should be able to demonstrate lots of examples of before/after photographs;  if the prospective patient does not like anything he/she sees (when it comes to the quality of the postoperative outcomes), then the plastic surgeon is likely not a "good fit".  In other words, appropriate quantity/quality of before/after photographs may be one of the factors that gives patients confidence that the plastic surgeon they are considering can achieve an outcome that they will be pleased with. Best wishes. 

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.