I want to center my nipple. Will I need to lower the fold with 300mod+ or 325hp? Shld I reduce the size of my areola? (photos)

I've seen two different doctors both suggesting something different. 1)Anatomical & lower the fold 2)300mod+ over the muscle or under. He prefers over I prefer under. 3)325hp unders. I am 34 5'5 130pnds BWD 12. I would like my nipple to be centered. I feel my breasts are getting saggy & are small. I don't want to look matronly or go to big either. Modest size with better appearance is my goal. Which one of these options will give me the best result for a fuller more centered looking breast?

Doctor Answers 7

What type of augmentation for me?

Every practice will have preferences based on their experience and artistic sense, and well as patient goals. Your pictures seem to indicate that your augmentation might do best with a moderate profile submuscular smooth round implant, but much can change based on your individual goals, what you wish to look like. Look for a board certified plastic surgeon in your area who you understand and connect with and can explain how and why for the result you are looking for.

Chicago Plastic Surgeon
4.1 out of 5 stars 39 reviews


You do look to have more of an oval breast footprint ( vertical dimension is less than horizontal ) and this is one of the few indications in my opinion for an anatomical implant which can be tailored to this foot print and as you are thin then under the muscle would be best

Best Options for Breast Augmentation

Without a direct examination, it is impossible to say what will work best for you.  However, in general, most surgeons are not fans of the anatomically shaped implants in breast augmentation patients.  They are pretty firm, require a much bigger incision for placement, and do not move at all like a normal breast should.  95% of my patients are in the dual-plane position ( subpectoral), giving them muscle coverage where they are thinnest, but still allowing the breasts to be soft and and act natural.  As far as mod+ vs HP, the easiest way to think about it is that the mod+ has more of a natural appearance while the HP has a fuller appearance.  I hope this helps.

I want to center my nipple. Will I need to lower the fold with 300mod+ or 325hp? Shld I reduce the size of my areola?

Based on the photos, I think the volume that you are considering is appropriate. You have very minor asymmetry with youthful appearing breasts. I would suggest that you go behind the muscle, since there are many benefits to this, such as less risk of rippling and a decreased risk of forming a capsule. As your implants relax, the distance from your fold to your nipple will increase slightly. This will make your nipples appear more centered to you. I would not intentionally lower your fold. You could easily make an incision above your right areola and elevate it so that it is even with your left areola. Good luck!!

Best breast operation for me?

It is extremely common to receive different opinions from different plastic surgeons about the best way to treat a specific “problem”. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices.  

Although these different opinions can be confusing and a source of anxiety for patients, it is good for patients to understand the different options available. Ultimately, it will be up to each patient to do their due diligence and select their plastic surgeon carefully. Part of this selection process will involve the patients becoming comfortable with the plastic surgeon's experience level and abilities to achieve their goals as safely and complication free as possible. If I were you, I would ask to see as many examples as possible of similar patients who your plastic surgeons have helped.

There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”.    I will try to outline some of the differences here;  you may find the attached link helpful as well. 

I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes). The submuscular positioning  also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position. 

On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  they can be seen with breast implants placed in these sub muscular position.  

Whether or  not to reduce areola size will depend on your degree of concern with the areola size; I would vote against the procedure given the downsides of additional scarring.  Ultimately, you will need to consider the pros/cons associated with all options available.

Generally speaking, the best online advice I can give to ladies who are considering  breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals  with your plastic surgeon. This communication will be critical in determining  breast implant size/type/profile will most likely help achieve your goals. 

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as  “natural” or "C or D cup” to "look matronly" etc means different things to different people and therefore prove unhelpful.

 Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup  size may also be inaccurate.  Again, the use of computer imaging has been very helpful during the communication process, in our practice.

3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery,  after the use of temporary intraoperative sizers.

I hope this (and the attached link, dedicated to breast  augmentation surgery concerns) helps. Best wishes. 

Best way to center the nipple?

Thank you for your question and photos.  Everyone has some asymmetry of the breasts and sometimes it is one being slightly higher or larger or more lateral.  Small adjustments may be amenable to a Periareolar incision and others would require more extensive options.  There is not a large difference between 300 and 325 cc implants.  There is a significant difference between anatomic and round, as well as above or below the muscle.  The best place to start is with a board certified plastic surgeon who specializes in breast surgery and can show many before and afters to get a sense of their talent.  It is not always easy to move the nipple as it is centered on the breast.  If one moves the fold down then the nipple will appear to move higher on the breast.  This should be basic for the surgeon to explain and demonstrate.  Good luck.

David J. Wages, MD
Peabody Plastic Surgeon
5.0 out of 5 stars 18 reviews

I want to center my nipple. Will I need to lower the fold with 300mod+ or 325hp? Shld I reduce the size of my areola?

There are inaccuracies in giving advice based solely on photographs but if I saw a patient similar to yourself in my office, I would be discussing the fact that your areolae would probably be widened by the presence of an implant and suggesting a periareolar lift to narrow their diameter.  I think partial subpectoral mid-plus profile implants in a 300 to 325 mL range would be reasonable but would make the final decision during the surgical procedure when I can use test implants to check size, shape and contour with my patients in a semi-upright position.  Other doctors use a different approach but I agree with your goal of avoiding excessive volume and maintaining a more natural look.  As others have said, remember that your breasts are sisters and not twins and perfect symmetry cannot be expected though in my experience making breasts larger seems to make minor asymmetries "less important."

Please watch the video above for a description of my technique in choosing the best implant for my patient.  Good luck and best wishes.

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 29 reviews

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.