Nipple + Areola Too High After Breast Augmentation with Lift

i had an uplift with implants several years ago. my areola are very large and quite high up on breast. is there anyway this can now be lowered ? i have to be careful what tops i wear as it shows above the neckline on them.

Doctor Answers 46

High Nipples Can Be Fixed!

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In most cases, high riding nipples following breast augmentation is a straight forward, correctable problem. Often, the correction can be made under local anesthesia during a short office “lunchtime procedure”.

The options for correcting excessive nipple height following breast augmentation would include:

1. Tightening the implant pocket under local anesthesia with several strategically placed stitches without removing the implant

2. Surgically tightening up the implant pocket, usually requires implant removal and replacement (can use the same implant)

3. Changing the current implant to a larger size

4. Tightening the “skin bra” by surgical revision of the lift procedure

An example of such a correction can be seen at:

Good Luck,
Dr. P


High nipple position can often be fixed

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Nipple positions that end up too high after a breast augmentation with a lift usually occur for one of two reasons:

1) The implants placed were either placed too low to begin with, or they were too heavy for the breast tissue. In this situation, you can get a malposition of the implant in relation to nipple itself. This can be repaired by placing the repositioning the implant. Although a technically difficult opration, it is possible.

2) The new nipple position was set too high during your breast lift operation. This problem is also fixable in some patients, depending on the degree of nipple malposition.  Sometimes the implant will need to be downsized to help minimize the disproportion. Other patient may need to have more skin removed below the nipple-areola (i.e. re-do part of the lift). It really depends on the breast shape and degree of skin laxity.

Nipple Areola Mal-Position

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The treatment of superiorly mal-positioned nipple areola complexes following combination breast lift breast augmentation surgery is entirely dependent upon the cause of the problem. Unfortunately, in this case, it's virtually impossible to make a specific recommendation without pictures or a physical examination.

In some cases, the nipple areola complexes may have been set at a level that's too high. In other cases, the breast implants may have drifted downward causing elevation of the nipple areola.

Under these circumstances, the treatment is specific to the cause of the problem. In some cases, elevating the inframammary fold may be necessary and this may also require shortening of the distance from the areola to the inframammary fold. In other cases, decreasing the size of the areolas and breast implants may be necessary as well.

Although, this can be an extremely difficult problem to fix, these maneuvers have the potential to improve nipple areola complex position. If you're concerned about your nipple areola mal-position, consultation with your surgeon is appropriate. Your surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

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Too high

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It's too early to determine how your results look after surgery. Your nipple placement will most likely improve as you recover. This can take 4-6 months for a lift and augmentation. After that time, if your nipples are still too high you can discuss a revision with your surgeon.

Lowering Nipple and Areola

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There is usually a way to lower your nipples and areolae to a more favorable position. An examination is critical for the best opinion. Most likely you could benefit from raising your inframammary crease and converting the lollipop lift to a T to shorten the vertical scar creating more upper pole fullness. You may be a candidate for a graft. An exam is needed to confirm. Consult with a Board Certified Plastic Surgeon experienced in revisional surgery. See below for suggestions.

Breast augmentation, implant, enlargement

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This typically happens when the implants "bottom out" or the breast crease called as inframammary fold is obliterated or displaced downwards. To fix this problem your surgeon will reposition the implant higher up in relation to the nipple and fix the crease all along. Postsurgery you will wear a pressure garment that will help to prevent implant displacement initially.

Two main reasons why the nipples can end up too high

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There are two likely reasons why your nipples and areolar are now too high.  First, they may have been placed too high during your initial procedure.  Second, your implants may have "bottomed out" causing your nipples to rise.   Frequently, when implants become malpositioned, the nipple and areola tend to become displaced in the opposite direction.  The solution to your problem obviously depends on the cause.  If the nipples were placed to high initially and your implants are otherwise well positioned, there are not many options available to fix the issue.  Some authors have recommended expanding the superior poll, but this may be  costly and involve multiple operations.  If the problem is the position of the implant, repositioning the implant may correct the issue.  There are a variety of techniques available to reposition implants.  The best judge as to how your problem can be fixed will likely be a local board certified plastic surgeon.  Lastly, the areola can stretch out after a augmentation mastopexy if a buried permanent suture is not used as a preventative measure. 

Kelly Gallego, MD, FACS
Yuba City Plastic Surgeon

Unfortunately, this can occur following breast uplift and is a difficult problem to correct.

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Unfortunately, this can occur following breast uplift and is a difficult problem to correct.

Ideally, your nipples should lie approximate 21 cm from the notch between your clavicles at the lower part of your neck.

If the nipples are higher than this and are shown out of the top of your bra they may need lowering and making them smaller. The ideal diameter for the brown part of your nipple (areola) is approximately 4.5 cm and this is the ideal your surgeon should aim for.

I would suggest that if you're unhappy with the appearance of your bust you seek a further consultation with your surgeon to discuss the options of lowering and reducing your nipple size.

I wish you the best of luck if you do decide to go ahead with this treatment.

Nipples too high: a difficult problem to solve

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Dear jenkins in uk,

There are likely two causes of your problem:

  1. the implants have bottomed out
  2. the nipples were placed too high to begin with
  3. combination of 1 and 2

Neither are easy to fix. If the implants have bottomed out, the solution is to re-elevate them to a higher position. This tends to be difficult because the implant has a propensity to come back down due to gravity. Placing stitches to close down the lower portion of the pocket is tricky because there is a tendency for the skin to pucker, and the stitches to pull through the capsule with time.

If the nipple was simply placed too high, the goal is to lower it. If you simply reverse the process of elevating the nipple, you will leave scars above the nipple, so wearing a low cut top is still not practical. Surgeons usually resort to removing a crescent of skin along the area above the crease. Doing this pulls the nipple downwards but it also pulls the chest skin upwards, exacerbating the appearance of bottoming out.

My suggestion

If your problem is very troublesome, you should use all available methods. You may want to try replacing your implants with a smaller, textured device, sewing closed the lower portion of the implant pocket, and removing a crescent of skin just above the crease. Using a smaller implant will decrease the weight of the implant and lessen the tendency for bottoming out. The texturing tends to 'grip' the surrounding tissues making it less likely to slide downwards. Closing off the lower portion of the pocket will prevent it from falling back into its old spot again. The  use of a smaller and lighter implant in turn does not put as much stress on these pocket stitches. Removing the skin will pull the nipple downwards, shortening the distance between the crease and the nipple. It will also give the surgeon a much larger incision through which to more accurately place the stitches for closing off the pocket. This will decrease the risk of puckering of the skin as well. Good luck.

Best regards,

Lawrence Tong MD FACS FRCSC

Lawrence Tong, MD
Toronto Plastic Surgeon

Nipples Too High

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Nipples too high may either be secondary to the implants "bottoming out" in other words the crease beneath the breast descending from its original position, or your surgeon may have placed the nipple too high. If the breast implant has "bottomed out", the crease would need to be re-set or reconstructed in the correct position, and this can be somewhat difficult to do and maintain long term especially if large implants have been used. If the nipple has been placed to high, this is often an impossible situation to fix.

You mention that your areola is large, and this may indicate that your surgeon either made your areola too large, or it stretched out, and you would then need to have it made smaller and possibly have a purse-string permanent suture placed around the areola in the deeper layer of the skin to prevent this from happening again.

Wilfred Brown, MD
New York Plastic Surgeon

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.