I am 10 weeks post op and my right nipple is positioned higher on my breast and closer to the inside edge than the left breast. The right nipple now rides on the edge of my bra causing pain and discomfort. Can this be corrected without causing asymmetry issues?
Can Nipple Position Be Corrected After Breast Lift/augmentation? (photo)
Doctor Answers 15
I Want My Nipples At The Same Level
Thank you for your photograph and your excellent question. As you can see from the comments by responders, some of the best plastic surgeons in the country, we all think this problem is correctable, but everyone has a slightly different technique in mind. Obviously, the answer is to go back and see your plastic surgeon, who by the way did an excellent job, and ask his or her opinion as to what type of adjustment they would recommend.
All that being said, I would take a dart from your nipple down to your inframammary fold on the left. Depending on the angle of this dart, it will raise your nipple areolar complex a variable amount. One trick that we plastic surgeons use is known as tailor tacking. Here we put stitches on either side of the vertical line to determine how high your nipple would go and what angle we need to resect. This also requires a small adjustment on the fold at the bottom of your breast, and since your left breast is a little flatter, it will give a little more fullness to your left breast at the same time.
Breast Augmentation with Mastopexy (breast lift)
Thank you for the photos. Combining breast augmentation with mastopexy is extremely challenging and implant ptosis (the implant falling bellow where it should be) is one of the most common outcomes. It would be important to see the preoperative photos and discuss the case with your surgeon but there are a number of options to resolve the issue. First, excision of a crescent of tissue in the inframammary fold may help. Second, performing what it is called a "neo-subpectoral pocket" to place the implant in an internal sling and keep it elevated. Ultimately, you may have some postoperative asymetry but I think you will be happy.
Correcting nipple position.
Correction of the position can be performed. The recommendation is to wait for at least 6 months to allow all changes in the breast shape to finalize. Lowering is difficult but by removing skin from or tightening the lower portion of the breast, the nipple can be brought into better alignment.
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Nipple Height asymmetry after breast augmentation/mastopexy
Breast augmentation surgery when performed in conjunction with mastopexy surgery (breast lifting) can be one of the most difficult surgeries to predict the outcome. Almost all women have some degree of breast asymmetry which can be amplified with augmentation surgery. Your photo demonstrates a residual asymmetry in which your right nipple/areola complex is higher than your left side and there appears to be more skin from the edge of the right areola to the inframammary fold (where the breast meets the chest wall). Generally, if this persists, a minor revision can be done to correct this. It would be prudent to wait at least 6 months before a decision to revise the shape is made to assure that all of the swelling and shape changes have occurred. It will be important for you to follow-up with your surgeon at 3 months and 6 months to see how the changes to the breasts evolve.
Breast Augmentation - Asymmetric Nipples After BA/Lift?
No breast implant procedure is inherently more complicated than a combined breast augmentation and lift and, for that reason, it has a higher than average rate of revision. It is tricky enough so that some surgeons now recommend staging the procedures so that the lift is done first and then, several months later, the implants are inserted. I generally try to combine the procedures but it's with the understanding that revisions may be necessary. And perfect symmetry is even harder to achieve with this procedure than with implants alone (always impossible, of course, but always up there as an ideal!)
In your case it APPEARS (impossible to say via photos alone) that a relatively simple revision will provide better symmetry. Your right nipple is higher than your left and it looks like the distance from the nipple to the inframammary crease is longer on the right than on the left SO - it may be possible to remove a horizontally oriented ellipse from the IM crease that will pull the N/A down and shorten that distance. And if you get more symmetry with that - then I would leave it alone. Whatever the intent, it's possible that things can be made worse, not better!
I hope that this helps and good luck,
Breast lift/aug nipple asymmetry
Thank you for the picture. Slight nipple areolar asymmetries are common after mastopexy augmentation but I do see your concern. I also agree your left breast has the correct shape and position. To lower the right nipple the distance from the breast crease to nipple can be shortened. Please wait at least 6 months after the initial surgery.
Minor asymmetries of breasts
Thanks for the photo which quite well delineates the issue of concern. Your right nipple is higher and the distance from it to the bottom of your breast is increased compared to the left side. This can be easily addressed by excising tissue from the lower part of the right breast which is a minor procedure that can usually be performed in the office with local anesthesia. Realize that your breasts will never be perfectly symmetrical nor will they age at the same rate.
Your results are good overall and this issue is a relatively minor one. It can be addressed any point in time and there is no advantage in waiting because it will not improve with time.
As symmetry after bba
Did you have any asymmetry prior to your surgery. Breast augmentation can make asymmetries worse. In any case I would wait at least 3-6 months and re-evaluate. Things may change.
Nipple position can be improved but too early to worry.
Augmentation and breast lift at the same time is one of the hardest cosmetic procedures that we do. This is because of the natural asymmetries present before surgery and the unpredictable evolution of shape after we are finished in the OR. After at least 3 but preferably 6 months, options and the need for revisional surgery can be considered. No further intervention will result in perfect symmetry and any additional surgery will involve some risk of complications and failure to correct the problem.
Your right breast nipple and areola is higher than the left and also appears higher on the right breast mound than ideal. Tightening the lower breast on the right will not lower the nipple position compared to the left side but it can visually improve the balance of the right breast. Essentially having the nipple closer to the point of furthest projection (like your left breast appears), rather than above this point as it is now.
It is also clear that your breasts have a nice shape and your scars are progressing very nicely. Stay in touch with your surgeon and carefully weigh your options about wanting further refinements.
Nipple position may be lowered by tightening lower pole some more
Although I do not have the benefit of seeing your preop. photos, your result certainly looks quite reasonable. You are correct of course - the right nipple is higher. Was it also higher preoperatively? It is very common for one nipple to be a little higher than the other among normal unoperated women.
As for the issue with your bra, the only way to "lower" the right nipple is by removing some tissue from the lower pole of the breast, tightening the lower pole, and lifting the breast mound, so that the nipple is a little lower relative to the most projecting point of the breast mound.
It is not unusual for me to tighten a breast lift in this manner, to improve perkiness. There is no other good way to lower a nipple (to do so would leave scarring that you could see above the nipple).
But your present result certainly is OK and there is no need to do anything right away. I've attached the relevant portion of my website.
Eric Swanson, M.D.
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