Nipple + Areola Too High After Breast Augmentation with Lift

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.

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.

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.

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. 

There may be one of two possible problems:  One possibility is that your implants have descended or moved downward on your chest relative to the breast.  If this is the case, treatment consists of elevating your inframammary fold (i.e. the crease underneath the breast) with sutures or possibly additional skin resection with a revision mastopexy. 

The other possibility is that your nipple-areola complex is truly too high on your breast.  The second scenario would also require revision breast surgery, possibly with breast tissue expanders.

Best wishes,

Jaime Perez M.D.

Correcting nipple position after any breast surgery can be a difficult procedure.  But it can be done and sometimes not with significant scarring.  The reason for high nipples will help determine what needs to be done.  This reason can be nipple related or implant related. 

1) The nipple position may have been placed in a high position at the initial surgery.  If this is the case, some of the skin below the nipple may need to be removed with new scars placed.  Also, depending on how far the nipple has to move, scars may be needed above the nipple.

2) Sometimes, the implant can be placed too low or drop over time.  This situation can be fixed by repositioning the implant.  Unfortunately, the procedure is not as simple as putting the implant in a new position as it has to stay there.  It can be done, but it is technically difficult and sometimes there will be recurrence of the original problem.

Nipple position is important in breast surgery especially when you combine a lift with an augmentation.  This is very difficult to combine and many surgeons will not perform both procedures at the same time.  Nipples being too low is more common and easier to fix; nipples being too high is difficult to correct.

This may be due to implants "bottoming out" or sliding beneath the fold of the breast, or improper nipple positioning at the time of the operation.  Attempting to reduce the size of the areola may help "lower" the position by as much as 1 or 1.5 cm (reverse donut lift) but you really need to be careful because it can also make things worse in the long run.

Thanks for your question.  

There are several factors which determine the height of the nipple/areola following a lift.  In most cases, the nipple is positioned too low but it can also be raised too much.  When this happens, although it can be fixed, the solution is not that easy.  

One option would be to remove a wedge of tissue from the base of your breast and essentially bring down the nipple to a lower position on the breast mound itself.  This would also reduce the distance from the fold to the nipple and so there needs to be a reasonable distance there before actually attempting this procedure.

I hope this helps!

Hello,

Thanks for your question.  The causes of over descended implants and nipple areola complex malposition are many: too large an implant, thin skin envelope, miscalculation of amount of lift, surgical disruption of the inframammary fold, etc.  It is difficult to drop the position of the nipple after it has over lifted.  One common method for fixing the problem is to decrease the size of the implant and reduce the size of the over-stretched capsule internally.  This moves the position of the implant higher on the chest allowing for better centering of the implant under the nipple areolar complex.  Another option is to remove the horizontal excess of skin and capsule at the inframammary fold to force the implant upwards.  This does leave an external scar that typically fades nicely with time.  I have used the latter approach successfully on several patients and the scar has not been a problem since it is typically hidden at the inframammary fold.

Good luck,

Dr. Shah

Combining breast augmentation and breast lift is a rather formidable procedure.  The surgeon needs to be well trained, experienced and talented to execute this procedure successfully.  Your condition is difficult, but not impossible to correct.  It could be possible to reposition your implants higher, so that your areola complex is more centered.  On the other hand either partial or full revision of your breast lift will need to be done.  As I said, it is a complex problem to correct , make sure your surgeon has created a well thought out plan, and is able to execute it well.