Why Do my Nipple Stick out After Breast Augmentation? (photo)

 You are young and have fairly large breast implants.  Because the tissue under your nipples are still firm (with young patients) as the breast is enlarged so does the nipple stick out more and can often become more sensitive for this reason.  Don't worry, you are only 4 months out from surgery, and as the breasts soften and the implants descend further this look will improve. You will look great in about 6 months.... just wait and see.

Increased nipple projection is a relatively normal finding
following breast augmentation surgery. This occurs for a variety of reasons,
including swelling and the pressure that’s exerted by the underlying breast
implant.Although
it may take time, this problem usually always resolves as swelling decreases
and the breast tissue adjust to the presence of an underlying breast implant. If
you’re concerned about this issue, it’s important to discuss the problem with
your plastic surgeon.Your surgeon
should be able to discuss your increased nipple projection and alleviate your
anxiety.

Your nipple projection looks normal to me. I'm sure that they seem more projecting since your whole breast is now more projecting. You would really need to check your pre-op photos to re-evaluate. I agree with others that it also appears that the implants are still a bit too high, though I'm not convinced it is from a capsule contracture.

Nipple and areola swelling and increased projection is very normal after breast augmentation.  This will improve with time and likely will settle to a very acceptable appearance.  The cause is usually swelling but there is some increased pressure from the implant itself on the backside of the breast and nipple/areola.  The treatment is just more time- this will improve as your swelling subsides and your implants fall into a more approrpriate position. 

Even for the most toned musculature and taut, youthful skin, 4 months is certainly adequate time for the vast majority of breast augmentation patients to have their implant position drop, soften, and settle away from the "high, tight" look you still have.

To my eye (thanks for including photos, they are very helpful in giving better answers), this is not just an issue of nipple protrusion, but rather what appears to be a Baker 4 capsular contracture. You still look abnormally high and round superiorly (what many would call the "Baywatch look"), and without examination I can only speculate about implant movement (or lack thereof) in your pockets. If indeed your breasts are both firm and move very little in their respective pockets, then you have capsular contracture, and this gives you not only the high round appearance we have been discussing, but puts abnormal pressure on your nipple/areola complexes, causing or aggravating the protrusion you ask about. In some cases, this degree of capsular contracture can also be painful.

If your breasts are soft, then capsular contracture is less likely, and this may simply be slightly too-high position for your implants, or perhaps implants that are a bit too big for your frame and tissues.

You need to see your plastic surgeon (or another ABPS-certified plastic surgeon for second opinion) to discuss this. Occasionally, leukotriene inhibitor therapy (oral Singulair or Accolate plus vitamin E) may help reduce the severity of capsular contracture, but in severe cases, only surgery to release or remove the capsules will offer relief or improvement of this tightness and nipple protrusion. Make an appointment to see your plastic surgeon and have this evaluated and a plan formulated. For more information about capsular contracture click on the web reference link below. Best wishes! Dr. Tholen